Provider Demographics
NPI:1528561768
Name:PEEBLES-DORIN, MAGGIE (PHD)
Entity type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:
Last Name:PEEBLES-DORIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 FIFTH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3715
Mailing Address - Country:US
Mailing Address - Phone:914-368-2995
Mailing Address - Fax:
Practice Address - Street 1:629 FIFTH AVE STE 201
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-3715
Practice Address - Country:US
Practice Address - Phone:914-368-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
NY68-P132407-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist