Provider Demographics
NPI:1093514143
Name:DORFMAN, TED ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:ROBERT
Last Name:DORFMAN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5478
Mailing Address - Country:US
Mailing Address - Phone:724-454-2209
Mailing Address - Fax:
Practice Address - Street 1:1602 BROAD ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5478
Practice Address - Country:US
Practice Address - Phone:724-454-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004780-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist