Provider Demographics
NPI:1003287665
Name:POOLE-SEYMOUR, DWAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:
Last Name:POOLE-SEYMOUR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DWAYNE
Other - Middle Name:POOLE
Other - Last Name:SEYMOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:931 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2617
Mailing Address - Country:US
Mailing Address - Phone:718-551-6723
Mailing Address - Fax:
Practice Address - Street 1:154 W 127TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3739
Practice Address - Country:US
Practice Address - Phone:212-749-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090313102L00000X, 104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist