Provider Demographics
NPI:1265593180
Name:WHALEN, DOROTHY J (LCSW,RN, CASAC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:J
Last Name:WHALEN
Suffix:
Gender:F
Credentials:LCSW,RN, CASAC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:J
Other - Last Name:WHALEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW RN ACSW
Mailing Address - Street 1:54 WINTERBERRY CIRCLE, CROSS RIVER, NY, USA
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-1310
Mailing Address - Country:US
Mailing Address - Phone:845-661-7622
Mailing Address - Fax:
Practice Address - Street 1:54 WINTERBERRY CIRCLE, CROSS RIVER, NY, USA
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518-1310
Practice Address - Country:US
Practice Address - Phone:845-661-7622
Practice Address - Fax:914-669-8361
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO39310-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR039319-1OtherSTATE LICENSE NUMBER
NY3771OtherNY SUBSTANCE REGISTRATION
NYR039319-1OtherSTATE LICENSE NUMBER