Provider Demographics
NPI:1184877854
Name:DOLAN, JENNIFER LYNN (MST)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DOLAN
Suffix:
Gender:F
Credentials:MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WESTVIEW AVE APT 502
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-4119
Mailing Address - Country:US
Mailing Address - Phone:194-771-9893
Mailing Address - Fax:
Practice Address - Street 1:2500 WESTCHESTER AVENUE
Practice Address - Street 2:ALL ABOUT KIDS
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577
Practice Address - Country:US
Practice Address - Phone:914-251-0905
Practice Address - Fax:914-251-1266
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst