Provider Demographics
NPI:1255370862
Name:DUNN, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2673
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12325-0673
Mailing Address - Country:US
Mailing Address - Phone:518-393-6551
Mailing Address - Fax:518-377-9222
Practice Address - Street 1:806 KARENWALD LN
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6414
Practice Address - Country:US
Practice Address - Phone:518-393-6551
Practice Address - Fax:518-377-9222
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR019177-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR019177-1OtherPROVIDER NUMBER
NYR019177-1OtherPROVIDER NUMBER
NY54916BMedicare ID - Type Unspecified