Provider Demographics
NPI:1285342089
Name:DEPOLITO, VERONICA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:DEPOLITO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:BOYLE - GRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:532 LOGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-3430
Mailing Address - Country:US
Mailing Address - Phone:845-775-9064
Mailing Address - Fax:
Practice Address - Street 1:75 CRYSTAL RUN RD STE 201
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7010
Practice Address - Country:US
Practice Address - Phone:845-692-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062521-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker