Provider Demographics
NPI:1417175944
Name:DOLAN, ELAINE GALE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:GALE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 76TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2902
Mailing Address - Country:US
Mailing Address - Phone:718-748-7558
Mailing Address - Fax:718-748-7558
Practice Address - Street 1:601 79TH ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3760
Practice Address - Country:US
Practice Address - Phone:718-748-7558
Practice Address - Fax:718-748-7558
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038369-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical