Provider Demographics
NPI:1750470852
Name:DOORNBOS, DONALD D (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:D
Last Name:DOORNBOS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4596
Mailing Address - Country:US
Mailing Address - Phone:607-765-6597
Mailing Address - Fax:607-203-1668
Practice Address - Street 1:38 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4596
Practice Address - Country:US
Practice Address - Phone:607-765-6597
Practice Address - Fax:607-203-1668
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000163351OtherEXCELLUS BLUE CROSS/BS