Healthcare Provider Details

I. General information

NPI: 1740789460
Provider Name (Legal Business Name): DAHLEY DAWNN PRITCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BALDWIN PLACE RD
MAHOPAC NY
10541-2226
US

IV. Provider business mailing address

125 BALDWIN PLACE RD
MAHOPAC NY
10541-2226
US

V. Phone/Fax

Practice location:
  • Phone: 845-628-2280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099049-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: