Healthcare Provider Details

I. General information

NPI: 1447678701
Provider Name (Legal Business Name): JACQUELYN DOLAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 JACKSON AVE
SEAFORD NY
11783-2606
US

IV. Provider business mailing address

87 N WALNUT ST
N MASSAPEQUA NY
11758-3015
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-8888
  • Fax:
Mailing address:
  • Phone: 516-384-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: