Provider Demographics
NPI:1255375499
Name:HYDE, DOROTHY (DCSW)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CONIFER CT
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2124
Mailing Address - Country:US
Mailing Address - Phone:631-262-9543
Mailing Address - Fax:631-262-9543
Practice Address - Street 1:120 BETHPAGE ROAD, SUITE 201
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801
Practice Address - Country:US
Practice Address - Phone:516-931-7280
Practice Address - Fax:516-931-7280
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR025015-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP537880OtherOXFORD
NY7401185OtherGHI/VALUE OPTIONS
NYAA70707OtherMDNY
NYP537880OtherOXFORD