Provider Demographics
NPI:1770718140
Name:DALTON, ELIZABETH MARY (MS SPECIAL ED)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARY
Last Name:DALTON
Suffix:
Gender:F
Credentials:MS SPECIAL ED
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:FIORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SPECIAL ED
Mailing Address - Street 1:251 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1915
Mailing Address - Country:US
Mailing Address - Phone:718-948-4879
Mailing Address - Fax:
Practice Address - Street 1:251 WILSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1915
Practice Address - Country:US
Practice Address - Phone:718-948-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency