Provider Demographics
NPI:1851456545
Name:GLOWACKI, DALE SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DALE
Middle Name:SUZANNE
Last Name:GLOWACKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DALE
Other - Middle Name:SUZANNE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 GREEN LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4030
Mailing Address - Country:US
Mailing Address - Phone:516-579-3167
Mailing Address - Fax:
Practice Address - Street 1:64 DIVISION AVE STE 215E
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2947
Practice Address - Country:US
Practice Address - Phone:516-579-3167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0238651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300107940Medicare PIN