Provider Demographics
NPI:1740730654
Name:WHITTON, DOROTHY
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:WHITTON
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 1:107 HIGH AVE
Mailing Address - Street 2:# 207
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2500
Mailing Address - Country:US
Mailing Address - Phone:845-323-5171
Mailing Address - Fax:
Practice Address - Street 1:107 HIGH AVE
Practice Address - Street 2:# 207
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2500
Practice Address - Country:US
Practice Address - Phone:845-323-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279663-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional