Provider Demographics
NPI:1306941729
Name:DZIKOWSKI, DONNAMARIE (LCSW)
Entity type:Individual
Prefix:
First Name:DONNAMARIE
Middle Name:
Last Name:DZIKOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4732
Mailing Address - Country:US
Mailing Address - Phone:516-769-8453
Mailing Address - Fax:
Practice Address - Street 1:221 BROADWAY
Practice Address - Street 2:SUITE 202B
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2780
Practice Address - Country:US
Practice Address - Phone:631-574-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045761-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY248382000OtherMAGELLAN PROV #
NY105473579OtherUBH PROV#
NY7302084OtherAETNA PROV #
NY7480825OtherGHI PIN#
NY127510OtherVYTRA PIN#
NYP2471074OtherOXFORD PROV #
NY164289OtherVALUE OPTIONS PIN#
NY105473579OtherUBH PROV#