Provider Demographics
NPI:1013330976
Name:DORFMAN, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19656 E COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2599
Mailing Address - Country:US
Mailing Address - Phone:954-817-5310
Mailing Address - Fax:
Practice Address - Street 1:12301 TAFT ST
Practice Address - Street 2:SUITE #200
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4387
Practice Address - Country:US
Practice Address - Phone:954-312-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist