Provider Demographics
NPI:1346319597
Name:DWYER, EILEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21536 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1314
Mailing Address - Country:US
Mailing Address - Phone:718-279-3390
Mailing Address - Fax:718-565-9437
Practice Address - Street 1:21536 48TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1314
Practice Address - Country:US
Practice Address - Phone:718-279-3390
Practice Address - Fax:718-565-9437
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR015469-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical