Provider Demographics
NPI:1346069507
Name:RACINE, DORENE (MHC)
Entity type:Individual
Prefix:MS
First Name:DORENE
Middle Name:
Last Name:RACINE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 EMERSON PLZ W APT 14A
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1826
Mailing Address - Country:US
Mailing Address - Phone:845-270-3888
Mailing Address - Fax:
Practice Address - Street 1:136 MADISON AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6796
Practice Address - Country:US
Practice Address - Phone:845-270-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-05
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP126332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health