| The Dorm Lcsw, Pllc | |
|
175 W 72nd St Frnt 2 New York NY 10023-3203 | |
| (877) 909-3676 | |
| Not Available |
| Full Name | The Dorm Lcsw, Pllc |
|---|---|
| Speciality | Psychologist - Counseling |
| Location | 175 W 72nd St Frnt 2, New York, New York |
| Authorized Official Name and Position | Laura Baker (DIRECTOR OF CLINICAL OPERATIONS) |
| Authorized Official Contact | 2028932106 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Dorm Lcsw, Pllc 175 W 72nd St Frnt 2 New York NY 10023-3203 Ph: () - | The Dorm Lcsw, Pllc 175 W 72nd St Frnt 2 New York NY 10023-3203 Ph: (877) 909-3676 |
| NPI Number | 1962018713 |
|---|---|
| Provider Enumeration Date | 09/17/2020 |
| Last Update Date | 10/04/2021 |
| Certification Date | 10/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962018713 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
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