Provider Demographics
NPI:1417164641
Name:DELOURDES DALLIN, MARIA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:DELOURDES DALLIN
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 1:10 BLUE SKY BLVD
Mailing Address - Street 2:
Mailing Address - City:WURTSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12790-4601
Mailing Address - Country:US
Mailing Address - Phone:845-794-3300
Mailing Address - Fax:845-794-6547
Practice Address - Street 1:720 ROUTE 17M
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-341-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0679201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical