Provider Demographics
NPI:1205904786
Name:DORFMAN, MANDY BETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:BETH
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 YALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1253
Mailing Address - Country:US
Mailing Address - Phone:215-364-0672
Mailing Address - Fax:215-364-2672
Practice Address - Street 1:541 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3786
Practice Address - Country:US
Practice Address - Phone:215-355-3400
Practice Address - Fax:215-364-2672
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health