Provider Demographics
NPI:1497855092
Name:ROCKITTER-DAKSS, LYNN
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:ROCKITTER-DAKSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:A
Other - Last Name:DAKSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:100 MANETTO HILL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1311
Mailing Address - Country:US
Mailing Address - Phone:516-921-5651
Mailing Address - Fax:516-364-9402
Practice Address - Street 1:100 MANETTO HILL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-931-1450
Practice Address - Fax:516-364-9402
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-028909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-1215655OtherTAX IDENTIFICATION NUMBER