Provider Demographics
NPI:1164136958
Name:PASSMORE, DELORES SHARON (LMSW)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:SHARON
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06278-0321
Mailing Address - Country:US
Mailing Address - Phone:718-290-4567
Mailing Address - Fax:
Practice Address - Street 1:24933 147TH RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2429
Practice Address - Country:US
Practice Address - Phone:718-290-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6383104100000X
NY063318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker