Provider Demographics
NPI:1386801702
Name:DORMAN, STEPHANIE LIL (LMSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LIL
Last Name:DORMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RIDGE RD
Mailing Address - Street 2:BVS
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:04828-9700
Mailing Address - Country:US
Mailing Address - Phone:716-828-9670
Mailing Address - Fax:
Practice Address - Street 1:650 RIDGE RD
Practice Address - Street 2:BVS
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:04828-9700
Practice Address - Country:US
Practice Address - Phone:716-828-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060469-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker