Provider Demographics
NPI:1164894077
Name:COMPASSIONATE CARE DOULA
Entity Type:Organization
Organization Name:COMPASSIONATE CARE DOULA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIRTH AND POSTPARTUM DOULA
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:CD(TBA)
Authorized Official - Phone:631-268-4119
Mailing Address - Street 1:6 GRENDON LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1015
Mailing Address - Country:US
Mailing Address - Phone:631-268-4119
Mailing Address - Fax:
Practice Address - Street 1:6 GRENDON LN
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1015
Practice Address - Country:US
Practice Address - Phone:631-268-4119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty