Provider Demographics
NPI:1891366076
Name:DORSEY, STEPHEN WAYNE (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WAYNE
Last Name:DORSEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 THUNDERBIRD DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2211
Mailing Address - Country:US
Mailing Address - Phone:201-478-1598
Mailing Address - Fax:
Practice Address - Street 1:317 GODWIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1547
Practice Address - Country:US
Practice Address - Phone:201-444-8103
Practice Address - Fax:201-444-8105
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00194400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist