Provider Demographics
NPI:1043319593
Name:DYER, JAMES L (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:DYER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 PARTRIDGEVILLE ROAD
Mailing Address - Street 2:P.O. BOX 247
Mailing Address - City:BRANTINGHAM
Mailing Address - State:NY
Mailing Address - Zip Code:13312
Mailing Address - Country:US
Mailing Address - Phone:315-248-4145
Mailing Address - Fax:
Practice Address - Street 1:7714 NUMBER THREE RD
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-3521
Practice Address - Country:US
Practice Address - Phone:315-376-5958
Practice Address - Fax:313-376-5953
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20160101YA0400X
NY072140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker