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Dr. Donna Tyese Bacon, Ed.D, LCSW, MSW, CT

Social Worker, Clinical in Amityville, NY. Individual provider (NPI-1).

NPI number1821368077
StatusActive
Last updated in NPPESJan 5, 2012

Details

NPI
1821368077
Entity type
Individual (NPI-1)
Name
Dr. Donna Tyese Bacon
Credential
Ed.D, LCSW, MSW, CT
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 5, 2012
Last updated
Jan 5, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, Clinical070446NYYes

Practice location

15 Harrison Ave
#1a
Amityville, NY 11701-2426

Phone 516-884-4802

Mailing address

15 Harrison Ave
#1a
Amityville, NY 11701-2426

Phone 516-572-7528

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