Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | NY |
NPI | 1073737961 |
---|---|
Provider Name | Mr. Steven Edward Dolan |
First Address | Waterloo, NY 13165-1111 |
Second Address | Waterloo, NY 13165-1111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 26/07/2007 |