Healthcare Provider Details

I. General information

NPI: 1952545873
Provider Name (Legal Business Name): DAWN ILISA YABLONSKY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 JEFFERSON ST
MERRICK NY
11566-3312
US

IV. Provider business mailing address

117 JEFFERSON ST
MERRICK NY
11566-3312
US

V. Phone/Fax

Practice location:
  • Phone: 516-665-9309
  • Fax:
Mailing address:
  • Phone: 516-665-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number071707-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: