Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 695 | VT |
N | 103T00000X | Psychologist | 695 | VT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 695 | VT |
N | 103G00000X | Clinical Psychologist | 695 | VT |
N | 103TC0700X | Clinical Psychologist | 695 | VT |
N | 103TC1900X | Counseling Psychologist | 695 | VT |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 695 | VT |
N | 103TF0000X | Family Psychologist | 695 | VT |
NPI | 1104986637 |
---|---|
Provider Name | Mr. Jeffrey Dworkin |
First Address | Montpelier, VT 05602 |
Second Address | Montpelier, VT 05602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1007379 | (05) | VT |