Provider Demographics
NPI:1043464266
Name:DEAN, JOAN (LMSW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:28 HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1407
Mailing Address - Country:US
Mailing Address - Phone:515-214-0350
Mailing Address - Fax:
Practice Address - Street 1:28 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1407
Practice Address - Country:US
Practice Address - Phone:516-214-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0150401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0150401Medicaid