Provider Demographics
NPI:1033510227
Name:DOLGIN, INNA (MA ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:DOLGIN
Suffix:
Gender:F
Credentials:MA ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 OCEAN AVE APT 5K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5451
Mailing Address - Country:US
Mailing Address - Phone:646-280-5680
Mailing Address - Fax:
Practice Address - Street 1:2148 OCEAN AVE STE 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1484
Practice Address - Country:US
Practice Address - Phone:646-280-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001603103K00000X
NY1373660174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst