Individual
MISS DOREEN J ZYDOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NYS CASAC- T, NYCPS
Contact information
Practice address
28 HORSESHOE LN, CALLICOON, NY 12723-5414
(845) 791-0170
Mailing address
28 HORSESHOE LN, CALLICOON, NY 12723-5414
(845) 791-0170
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
33852
NY
175T00000X
Peer Specialist
Primary
NYCPS-P-1777
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33852
NYS OASAS
NY
05
—
DY28409Z
—
NY
01
—
NYCPS-P-1777
NY PEER SPECIALIST
NY
Enumeration date
04/02/2019
Last updated
04/02/2019
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