Provider Demographics
NPI:1619949351
Name:QUILTY, DOROTHY A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:A
Last Name:QUILTY
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 1:6 GRIFFEN CT
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1431
Mailing Address - Country:US
Mailing Address - Phone:631-473-7115
Mailing Address - Fax:631-473-8282
Practice Address - Street 1:6 GRIFFEN CT
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1431
Practice Address - Country:US
Practice Address - Phone:631-473-7115
Practice Address - Fax:631-473-8282
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0233281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN26961Medicare ID - Type Unspecified