Provider Demographics
NPI:1609059369
Name:PRINCE, DENNIS ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ANTHONY
Last Name:PRINCE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14904 262ND ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3007
Mailing Address - Country:US
Mailing Address - Phone:718-525-1276
Mailing Address - Fax:
Practice Address - Street 1:12118 155TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2325
Practice Address - Country:US
Practice Address - Phone:347-582-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075640-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical