Provider Demographics
NPI:1518477033
Name:DOWLING, MARY ALICE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY ALICE
Middle Name:
Last Name:DOWLING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 GRAND BLVD STE 17
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5725
Mailing Address - Country:US
Mailing Address - Phone:631-392-4357
Mailing Address - Fax:
Practice Address - Street 1:770 GRAND BLVD STE 17
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5725
Practice Address - Country:US
Practice Address - Phone:631-392-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402209-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health