Provider Demographics
NPI:1265401012
Name:DOLIN, ELLEN SMITH (MSSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:SMITH
Last Name:DOLIN
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E OCEAN BLVD
Mailing Address - Street 2:SUITE D 232
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2471
Mailing Address - Country:US
Mailing Address - Phone:772-288-4242
Mailing Address - Fax:772-288-1049
Practice Address - Street 1:900 E OCEAN BLVD
Practice Address - Street 2:SUITE D 232
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2471
Practice Address - Country:US
Practice Address - Phone:772-288-4242
Practice Address - Fax:772-288-1049
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1724Medicare ID - Type Unspecified