| Dufort Psychological Services Pllc | |
|
401 Bloomingdale Rd Suite 6 Staten Island NY 10309 | |
| (347) 880-2150 | |
| Not Available |
| Full Name | Dufort Psychological Services Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 401 Bloomingdale Rd Suite 6, Staten Island, New York |
| Authorized Official Name and Position | Dawson Dufort (OWNER) |
| Authorized Official Contact | 3478802150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dufort Psychological Services Pllc 401 Bloomingdale Rd Ste 6 Staten Island NY 10309-2070 Ph: (347) 880-2150 | Dufort Psychological Services Pllc 401 Bloomingdale Rd Suite 6 Staten Island NY 10309 Ph: (347) 880-2150 |
| NPI Number | 1053822544 |
|---|---|
| Provider Enumeration Date | 10/24/2017 |
| Last Update Date | 10/24/2017 |
| Medicare PECOS PAC ID | 8729341144 |
|---|---|
| Medicare Enrollment ID | O20180418001409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053822544 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
| Provider Name | Dawson D Dufort |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316286800 PECOS PAC ID: 7012292477 Enrollment ID: I20170327001152 |
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