Provider Demographics
NPI:1053822544
Name:DUFORT PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:DUFORT PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFORT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:347-880-2150
Mailing Address - Street 1:401 BLOOMINGDALE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2070
Mailing Address - Country:US
Mailing Address - Phone:347-880-2150
Mailing Address - Fax:
Practice Address - Street 1:401 BLOOMINGDALE RD SUITE 6
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309
Practice Address - Country:US
Practice Address - Phone:347-880-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty