Provider Demographics
NPI:1720280597
Name:FRATELLO, DOREEN LORRAINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:LORRAINE
Last Name:FRATELLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:LORRAINE
Other - Last Name:PABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-1805
Mailing Address - Country:US
Mailing Address - Phone:631-369-4134
Mailing Address - Fax:
Practice Address - Street 1:1490 WILLIAM FLOYD PARKWAY
Practice Address - Street 2:SUITE 108
Practice Address - City:EAST YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11967-1820
Practice Address - Country:US
Practice Address - Phone:631-924-3741
Practice Address - Fax:631-924-2413
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06796311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical