Provider Demographics
NPI:1225174535
Name:DELISE, DENISE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:M
Last Name:DELISE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:DALOIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792
Mailing Address - Country:US
Mailing Address - Phone:631-838-5264
Mailing Address - Fax:631-744-0865
Practice Address - Street 1:37 RANDELL RD
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792
Practice Address - Country:US
Practice Address - Phone:631-838-5264
Practice Address - Fax:631-744-0865
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03821611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
535764OtherVALUE OPTION