Provider Demographics
NPI:1730123233
Name:DORF, MERYL WEINMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MERYL
Middle Name:WEINMAN
Last Name:DORF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MERYL
Other - Middle Name:
Other - Last Name:WEINMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:395 PLEASANT VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-419-0455
Mailing Address - Fax:
Practice Address - Street 1:395 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-419-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009739103T00000X, 103TP0814X
NJ3825103T00000X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV46861Medicare PIN