Provider Demographics
NPI:1144657651
Name:DORMEUS, JOSEPH I (LMSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:I
Last Name:DORMEUS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 104TH ST
Mailing Address - Street 2:APT. 2-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4232
Mailing Address - Country:US
Mailing Address - Phone:917-373-4325
Mailing Address - Fax:
Practice Address - Street 1:140 W 104TH ST
Practice Address - Street 2:APT. 2-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4232
Practice Address - Country:US
Practice Address - Phone:917-373-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069850-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst