Provider Demographics
NPI:1811221898
Name:DOSTIE, CHERYL ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:DOSTIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:SIDEROWF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:49 TROLLEY CROSSING LANE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-395-8509
Mailing Address - Fax:
Practice Address - Street 1:90 FRANKLIN SQ
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-225-3561
Practice Address - Fax:860-225-2558
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT89981041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical