Provider Demographics
NPI:1669550539
Name:DALTON, KATHY LYNN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LYNN
Last Name:DALTON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1033
Mailing Address - Country:US
Mailing Address - Phone:516-935-6858
Mailing Address - Fax:516-935-2717
Practice Address - Street 1:385 W JOHN ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1033
Practice Address - Country:US
Practice Address - Phone:516-935-6858
Practice Address - Fax:516-935-2717
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04553-0101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNV3891Medicare ID - Type Unspecified