Provider Demographics
NPI:1861456485
Name:DALLINGA, CAROL A (LCSW CGP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:DALLINGA
Suffix:
Gender:F
Credentials:LCSW CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 SAW MILL RIVER ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ARDSELY
Mailing Address - State:NY
Mailing Address - Zip Code:10502
Mailing Address - Country:US
Mailing Address - Phone:914-693-6906
Mailing Address - Fax:914-693-2266
Practice Address - Street 1:731 SAW MILL RIVER ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:ARDSELY
Practice Address - State:NY
Practice Address - Zip Code:10502
Practice Address - Country:US
Practice Address - Phone:914-693-6906
Practice Address - Fax:914-693-2266
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02786211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN002910Medicare ID - Type Unspecified