Provider Demographics
NPI:1255697538
Name:DAPOLITO, DONNA M (LCSWR)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:DAPOLITO
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-8464
Mailing Address - Country:US
Mailing Address - Phone:518-882-7120
Mailing Address - Fax:
Practice Address - Street 1:1153 BURGOYNE AVENUE, SUITE 2
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1134
Practice Address - Country:US
Practice Address - Phone:518-746-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0710351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical