Provider Demographics
NPI:1730515156
Name:DORENDORF, KATHRYN LORRAINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LORRAINE
Last Name:DORENDORF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:DORENDORF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:221 GREENWICH CIR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2890
Mailing Address - Country:US
Mailing Address - Phone:561-429-2397
Mailing Address - Fax:561-429-2398
Practice Address - Street 1:221 GREENWICH CIR
Practice Address - Street 2:SUITE 111
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2890
Practice Address - Country:US
Practice Address - Phone:561-429-2397
Practice Address - Fax:561-429-2398
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical