Healthcare Provider Details

I. General information

NPI: 1740485960
Provider Name (Legal Business Name): DEENA MOGEL L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 STATE ROUTE 55
SWAN LAKE NY
12783
US

IV. Provider business mailing address

20 SUNSET DR
MONTICELLO NY
12701-4500
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-6880
  • Fax: 845-292-4873
Mailing address:
  • Phone: 845-794-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number065806
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: