Provider Demographics
NPI:1386331791
Name:DALLET PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:DALLET PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNRUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-657-0290
Mailing Address - Street 1:821 NEWBURG AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3107
Mailing Address - Country:US
Mailing Address - Phone:917-657-0290
Mailing Address - Fax:
Practice Address - Street 1:821 NEWBURG AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3107
Practice Address - Country:US
Practice Address - Phone:917-657-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty