Provider Demographics
NPI:1154470615
Name:DOLKART, VIVIAN ALINE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:ALINE
Last Name:DOLKART
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HANOVER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1312
Mailing Address - Country:US
Mailing Address - Phone:603-448-0126
Mailing Address - Fax:603-448-0129
Practice Address - Street 1:9 HANOVER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1312
Practice Address - Country:US
Practice Address - Phone:603-448-0126
Practice Address - Fax:603-448-0129
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1073301041C0700X
NH3571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80001925Medicaid
NH80001925Medicaid