Provider Demographics
NPI:1265700223
Name:DOOLAN, DIANE MARIE (MS, PD)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:DOOLAN
Suffix:
Gender:F
Credentials:MS, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:ROCK TAVERN
Mailing Address - State:NY
Mailing Address - Zip Code:12575-5131
Mailing Address - Country:US
Mailing Address - Phone:845-497-7647
Mailing Address - Fax:
Practice Address - Street 1:20 FARM TO MARKET RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2703
Practice Address - Country:US
Practice Address - Phone:845-279-4018
Practice Address - Fax:845-279-8154
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool