Provider Demographics
NPI:1538374301
Name:SLADE, DOROTHY SELVERSTONE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:SELVERSTONE
Last Name:SLADE
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 1:1025 NORTHERN BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576
Mailing Address - Country:US
Mailing Address - Phone:516-944-7954
Mailing Address - Fax:516-883-8432
Practice Address - Street 1:1025 NORTHERN BOULEVARD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576
Practice Address - Country:US
Practice Address - Phone:516-944-7954
Practice Address - Fax:516-883-8432
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038558-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical