Provider Demographics
NPI:1346782745
Name:DALZELL, JOHN E (MA, LMSW, MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:DALZELL
Suffix:
Gender:M
Credentials:MA, LMSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WEST 9TH STREET
Mailing Address - Street 2:# 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:917-943-5980
Mailing Address - Fax:
Practice Address - Street 1:26 W 9TH ST APT 3E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8923
Practice Address - Country:US
Practice Address - Phone:917-943-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092976-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker