Provider Demographics
NPI:1992950869
Name:EARLY START SERVICES LCSW PC
Entity type:Organization
Organization Name:EARLY START SERVICES LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:845-877-0103
Mailing Address - Street 1:83 HALLS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:DOVER PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12522-5200
Mailing Address - Country:US
Mailing Address - Phone:845-877-0103
Mailing Address - Fax:845-877-0103
Practice Address - Street 1:83 HALLS CORNERS RD
Practice Address - Street 2:
Practice Address - City:DOVER PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12522-5200
Practice Address - Country:US
Practice Address - Phone:845-877-0103
Practice Address - Fax:845-877-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0340491252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency