Provider Demographics
NPI:1124227491
Name:DEYNES, WILFREDO (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:
Last Name:DEYNES
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 1:2417 BATHGATE AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5907
Mailing Address - Country:US
Mailing Address - Phone:718-562-0963
Mailing Address - Fax:
Practice Address - Street 1:1 FORDHAM PLZ
Practice Address - Street 2:SUITE 1100
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5871
Practice Address - Country:US
Practice Address - Phone:718-405-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0608041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical