Provider Demographics
NPI:1508810896
Name:NOLLMAN, DOROTHY (MSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:NOLLMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2713
Mailing Address - Country:US
Mailing Address - Phone:631-366-4431
Mailing Address - Fax:
Practice Address - Street 1:118 LANDING AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2713
Practice Address - Country:US
Practice Address - Phone:631-366-4431
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013650-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY64078OtherVYTRA
NY7492876OtherVALUE OPTIONS
NYN9A431Medicare ID - Type UnspecifiedLCSW