Provider Demographics
NPI:1871719153
Name:GORFINKLE, KENNETH S (PHD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:S
Last Name:GORFINKLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 GREENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1619
Mailing Address - Country:US
Mailing Address - Phone:914-288-0803
Mailing Address - Fax:914-993-5182
Practice Address - Street 1:90 BRYANT AVE
Practice Address - Street 2:SUITE TDF
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1952
Practice Address - Country:US
Practice Address - Phone:917-270-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011022103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical