Active NPI
Jeffrey Dworkin, M.A.
- Clinical Child & Adolescent Psychologist
- Montpelier, VT
National Provider Identifier
1104986637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 695
- Practice address
- 24 Court St.
Montpelier, VT 05602 - Phone
- (802) 223-6733
- Fax
- (802) 223-6733
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 695 | VT | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 695 | VT | |
| Clinical Psychologist | 103TC0700X | 695 | VT | |
| Counseling Psychologist | 103TC1900X | 695 | VT | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 695 | VT | Primary |
| Family Psychologist | 103TF0000X | 695 | VT |
Addresses
Primary practice location
24 Court St.
Montpelier, VT 05602
Mailing address
24 Court St.
Montpelier, VT 05602
Phone (802) 223-6733
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007379 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 695 | VT | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1104986637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 COURT ST.",
"city": "MONTPELIER",
"state": "VT",
"postal_code": "05602",
"telephone_number": "802-223-6733",
"fax_number": "802-223-6733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 COURT ST.",
"city": "MONTPELIER",
"state": "VT",
"postal_code": "05602",
"telephone_number": "802-223-6733",
"fax_number": "802-223-6733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DWORKIN",
"first_name": "JEFFREY",
"name_prefix": "Mr.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VT",
"license": "695",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "VT",
"license": "695",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VT",
"license": "695",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "VT",
"license": "695",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "VT",
"license": "695",
"primary": true
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "VT",
"license": "695",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007379",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montpelier, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.