Provider Demographics
NPI:1215074349
Name:DORFMAN, BETH NITZBERG (MSSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:NITZBERG
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:W
Other - Last Name:NITZBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BETH
Mailing Address - Street 1:211 W 56TH ST
Mailing Address - Street 2:SUITE 11K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4312
Mailing Address - Country:US
Mailing Address - Phone:212-245-3980
Mailing Address - Fax:
Practice Address - Street 1:211 W 56TH ST
Practice Address - Street 2:SUITE 11K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4312
Practice Address - Country:US
Practice Address - Phone:212-245-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR024343-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4B501Medicare ID - Type UnspecifiedNASSAU COUNTY, NEW YORK