Basic Information
| Provider Information | |||||||||
| NPI: | 1720280597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRATELLO | ||||||||
| FirstName: | DOREEN | ||||||||
| MiddleName: | LORRAINE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PABO | ||||||||
| OtherFirstName: | DOREEN | ||||||||
| OtherMiddleName: | LORRAINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 152 MILL ROAD | ||||||||
| Address2: | |||||||||
| City: | MANORVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119491805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313694134 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1490 WILLIAM FLOYD PARKWAY | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | EAST YAPHANK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119671820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319243741 | ||||||||
| FaxNumber: | 6319242413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 1041C0700X | 0679631 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.