Provider Demographics
NPI:1386424570
Name:CHONGE, DORRETT (LMFT)
Entity type:Individual
Prefix:
First Name:DORRETT
Middle Name:
Last Name:CHONGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EXECUTIVE BLVD STE 178
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6836
Mailing Address - Country:US
Mailing Address - Phone:800-465-3203
Mailing Address - Fax:
Practice Address - Street 1:1 EXECUTIVE BLVD STE 178
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6836
Practice Address - Country:US
Practice Address - Phone:800-465-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06-P114065-01106H00000X
NY002336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist