Provider Demographics
NPI:1821031550
Name:DASHIELL, IRENE F (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:F
Last Name:DASHIELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OAK ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2887
Mailing Address - Country:US
Mailing Address - Phone:631-289-8765
Mailing Address - Fax:631-447-9717
Practice Address - Street 1:31 OAK ST
Practice Address - Street 2:SUITE 14
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2887
Practice Address - Country:US
Practice Address - Phone:631-289-8765
Practice Address - Fax:631-447-9717
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044441-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05161100Medicaid