Provider Demographics
NPI:1922734235
Name:DEVORKIN, ARYEH LEIB
Entity Type:Individual
Prefix:
First Name:ARYEH
Middle Name:LEIB
Last Name:DEVORKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4530 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53211-1215
Practice Address - Country:US
Practice Address - Phone:414-803-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7091-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor