Healthcare Provider Details

I. General information

NPI: 1265401012
Provider Name (Legal Business Name): ELLEN SMITH DOLIN MSSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E OCEAN BLVD SUITE D 232
STUART FL
34994-2471
US

IV. Provider business mailing address

900 E OCEAN BLVD SUITE D 232
STUART FL
34994-2471
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-4242
  • Fax: 772-288-1049
Mailing address:
  • Phone: 772-288-4242
  • Fax: 772-288-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW1655
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: