Provider Demographics
NPI:1629301783
Name:DORTCH, CHERIE Y (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHERIE
Middle Name:Y
Last Name:DORTCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 STEWART AVE
Mailing Address - Street 2:LL50
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4783
Mailing Address - Country:US
Mailing Address - Phone:516-305-2581
Mailing Address - Fax:516-489-6492
Practice Address - Street 1:585 STEWART AVE
Practice Address - Street 2:LL50
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4783
Practice Address - Country:US
Practice Address - Phone:516-305-2581
Practice Address - Fax:516-489-6492
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0803141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical