Provider Demographics
NPI:1104148329
Name:DASCOLI, JAIME LYNN
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:DASCOLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E ALHAMBRA AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6504
Mailing Address - Country:US
Mailing Address - Phone:516-637-4523
Mailing Address - Fax:
Practice Address - Street 1:208 E ALHAMBRA AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6504
Practice Address - Country:US
Practice Address - Phone:516-637-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR06921711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical