Provider Demographics
NPI:1619043403
Name:SLATER, DENNIS W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:W
Last Name:SLATER
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 1:4250 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4000
Mailing Address - Country:US
Mailing Address - Phone:631-331-7292
Mailing Address - Fax:631-474-4272
Practice Address - Street 1:4250 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 215
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4000
Practice Address - Country:US
Practice Address - Phone:631-331-7292
Practice Address - Fax:631-474-4272
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021742-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical