Provider Demographics
NPI:1467810036
Name:DOVE, BARBARA (PROGRAM DIRECTOR)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:DOVE
Suffix:
Gender:F
Credentials:PROGRAM DIRECTOR
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:DOVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PROGRAM DIRECTOR
Mailing Address - Street 1:293 MONTAUK AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3652
Mailing Address - Country:US
Mailing Address - Phone:347-824-7757
Mailing Address - Fax:
Practice Address - Street 1:293 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3654
Practice Address - Country:US
Practice Address - Phone:347-824-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker