Provider Demographics
NPI:1578981106
Name:BARCLAY, DOREEN M
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:M
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DOREEN
Other - Middle Name:M
Other - Last Name:DESMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3500 SUNRISE HWY
Mailing Address - Street 2:BUILDING 300
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-1001
Mailing Address - Country:US
Mailing Address - Phone:631-854-0167
Mailing Address - Fax:631-854-0176
Practice Address - Street 1:3500 SUNRISE HWY
Practice Address - Street 2:BUILDING 300
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-1001
Practice Address - Country:US
Practice Address - Phone:631-854-0167
Practice Address - Fax:631-854-0176
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116000464171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator