Individual
DELORES BOCKLET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-R, CASAC
Contact information
Practice address
401 MAIN ST, ISLIP, NY 11751-3560
(631) 224-5330
Mailing address
16 REDWOOD DR, GREAT RIVER, NY 11739
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
R-044537-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129255
VYTRA ,HIP
NY
01
—
7408265
VALUE OPTIONS
NY
01
—
P2739447
OXFORD
NY
Enumeration date
02/09/2007
Last updated
07/08/2007
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