Provider Demographics
NPI:1316363013
Name:ANNE DALTON MORABITO CSW PC
Entity Type:Organization
Organization Name:ANNE DALTON MORABITO CSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON-MORABITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-366-4677
Mailing Address - Street 1:48 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3223
Mailing Address - Country:US
Mailing Address - Phone:631-366-4677
Mailing Address - Fax:
Practice Address - Street 1:891 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3213
Practice Address - Country:US
Practice Address - Phone:631-366-4677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-032946-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02198983Medicaid
NYNY4011Medicare PIN