Provider Demographics
NPI:1417194150
Name:DWYER, B (MA PCC)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:MA PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # DESKP57
Mailing Address - Street 2:CLEVELAND CLINIC: DEPT OF PSYCHIATRY & PSYCHOLOGY
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-4836
Mailing Address - Fax:216-445-3879
Practice Address - Street 1:9500 EUCLID AVE # DESK P57
Practice Address - Street 2:CLEVELAND CLINIC: DEPT PSYCHIATRY & PSYCHOLOGY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-4836
Practice Address - Fax:216-445-3879
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0500356101Y00000X
OHC 0500356101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health