Provider Demographics
NPI:1982685939
Name:DORFMAN, ELLEN S (MA, LCSW, LPC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:S
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:MA, LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 LACLEDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2814
Mailing Address - Country:US
Mailing Address - Phone:314-276-9334
Mailing Address - Fax:314-289-9983
Practice Address - Street 1:4231 LACLEDE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2814
Practice Address - Country:US
Practice Address - Phone:314-276-9334
Practice Address - Fax:314-289-9983
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001903101YM0800X
MO0032041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical