1821031550 NPI number — MS. IRENE F DASHIELL LCSW

Table of content: MS. IRENE F DASHIELL LCSW (NPI 1821031550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821031550 NPI number — MS. IRENE F DASHIELL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DASHIELL
Provider First Name:
IRENE
Provider Middle Name:
F
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821031550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 OAK ST
Provider Second Line Business Mailing Address:
SUITE 14
Provider Business Mailing Address City Name:
PATCHOGUE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11772-2887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-289-8765
Provider Business Mailing Address Fax Number:
631-447-9717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 OAK ST
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-2887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-289-8765
Provider Business Practice Location Address Fax Number:
631-447-9717
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R044441-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05161100 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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