Provider Demographics
NPI:1790065613
Name:SOROKIN, JUDITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:SOROKIN
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 1:15 PARKWAY
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1505
Mailing Address - Country:US
Mailing Address - Phone:914-232-3846
Mailing Address - Fax:708-778-8017
Practice Address - Street 1:15 PARKWAY
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-1505
Practice Address - Country:US
Practice Address - Phone:914-232-3846
Practice Address - Fax:708-778-8017
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical