Provider Demographics
NPI:1720001332
Name:DORLESTER, JANE REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:REBECCA
Last Name:DORLESTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2506
Mailing Address - Country:US
Mailing Address - Phone:718-788-4991
Mailing Address - Fax:718-965-3099
Practice Address - Street 1:293 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2506
Practice Address - Country:US
Practice Address - Phone:718-788-4991
Practice Address - Fax:718-965-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024344-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP11015886143Medicaid
NYN71661Medicare ID - Type Unspecified