Provider Demographics
NPI:1679792873
Name:KINNEY, DALE ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DALE
Middle Name:ELIZABETH
Last Name:KINNEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:NANA
Other - Middle Name:AKUA
Other - Last Name:ANTWIWAA
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:QUEEN MOTHER -AFRICA
Mailing Address - Street 1:340 E MOSHOLU PKWY S
Mailing Address - Street 2:2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1742
Mailing Address - Country:US
Mailing Address - Phone:646-542-5326
Mailing Address - Fax:646-542-5326
Practice Address - Street 1:1441 OLD NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2146
Practice Address - Country:US
Practice Address - Phone:516-625-6846
Practice Address - Fax:516-625-0193
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022518-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker