Provider Demographics
NPI:1962052589
Name:DR RICHARD J DACKOW PSYCHOLOGY SERVICES
Entity type:Organization
Organization Name:DR RICHARD J DACKOW PSYCHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DACKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-288-4488
Mailing Address - Street 1:15 DONALD ST
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-1401
Mailing Address - Country:US
Mailing Address - Phone:516-330-4545
Mailing Address - Fax:516-654-8870
Practice Address - Street 1:15 DONALD ST
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1401
Practice Address - Country:US
Practice Address - Phone:516-330-4545
Practice Address - Fax:516-654-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty