Healthcare Provider Details

I. General information

NPI: 1821031550
Provider Name (Legal Business Name): IRENE F DASHIELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OAK ST SUITE 14
PATCHOGUE NY
11772-2887
US

IV. Provider business mailing address

31 OAK ST SUITE 14
PATCHOGUE NY
11772-2887
US

V. Phone/Fax

Practice location:
  • Phone: 631-289-8765
  • Fax: 631-447-9717
Mailing address:
  • Phone: 631-289-8765
  • Fax: 631-447-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR044441-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier05161100
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: