Provider Demographics
NPI:1598842494
Name:DORFMAN, CAROL J (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N DEAN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2532
Mailing Address - Country:US
Mailing Address - Phone:201-569-4422
Mailing Address - Fax:201-569-3550
Practice Address - Street 1:155 N DEAN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2532
Practice Address - Country:US
Practice Address - Phone:201-569-4422
Practice Address - Fax:201-569-3550
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ297018OtherMHN
2357794000OtherAMERIHEALTH/KEYSTONE/PC
2357794000OtherAMERIHEALTH/KEYSTONE/PC
NJ297018OtherMHN