=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316363013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNE DALTON MORABITO CSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2014
-----------------------------------------------------
Last Update Date | 03/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 891 MIDDLE COUNTRY RD
-----------------------------------------------------
City | SAINT JAMES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11780-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-366-4677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 IMPERIAL DR
-----------------------------------------------------
City | MILLER PLACE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11764-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-366-4677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANNE DALTON-MORABITO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-366-4677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | R-032946-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------