Provider Demographics
NPI:1831254598
Name:DVORKIN, JANICE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:DVORKIN
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 LARKDALE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5015
Mailing Address - Country:US
Mailing Address - Phone:210-590-6702
Mailing Address - Fax:
Practice Address - Street 1:1958 AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-2501
Practice Address - Country:US
Practice Address - Phone:210-590-9696
Practice Address - Fax:210-650-9696
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30553103TC0700X
NY11757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00406EMedicare ID - Type UnspecifiedPSYCHOLOGIST
TX256077Medicare UPIN
TX6858Medicare UPIN