Provider Demographics
NPI:1043603749
Name:DMC CONSULTANT GROUP, WBE, LLC
Entity Type:Organization
Organization Name:DMC CONSULTANT GROUP, WBE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:CONLEY-MORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:315-766-6729
Mailing Address - Street 1:8855 CENTER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1421
Mailing Address - Country:US
Mailing Address - Phone:315-766-6729
Mailing Address - Fax:315-303-5892
Practice Address - Street 1:8855 CENTER POINTE DR
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1421
Practice Address - Country:US
Practice Address - Phone:315-766-6729
Practice Address - Fax:315-303-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163WA0400X, 163WC1500X, 163WC1600X, 163WH0200X, 163WI0600X, 163WP0808X, 164W00000X
NY515009-1163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff DevelopmentGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WI0600XNursing Service ProvidersRegistered NurseInfection ControlGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03074935OtherREGISTERED NURSE LICENSE WHO WAS APPROVED WITH A MEDICAID NUMBER