Basic Information
| Provider Information | |||||||||
| NPI: | 1306148861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DZIEMASZKIEWICZ | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | BARBARA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 FOX HOLLOW RD | ||||||||
| Address2: | |||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125723640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458765400 | ||||||||
| FaxNumber: | 8458765362 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 ROBBINS ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035736232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 081392-1 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 081392-1 | 05 | NY | MEDICAID |