Provider Demographics
NPI:1093875817
Name:KANE-GLICKMAN, DANA (CSW)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:KANE-GLICKMAN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MCCULLOCH DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8304
Mailing Address - Country:US
Mailing Address - Phone:516-702-0957
Mailing Address - Fax:631-462-9198
Practice Address - Street 1:22 MCCULLOCH DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-8304
Practice Address - Country:US
Practice Address - Phone:516-702-0957
Practice Address - Fax:631-462-9198
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-029550-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical