Provider Demographics
NPI:1417661158
Name:OLADOKUN-DYBOWSKI, DANIEL GREGORY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:GREGORY
Last Name:OLADOKUN-DYBOWSKI
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 1:640 E PALO VERDE ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1628
Mailing Address - Country:US
Mailing Address - Phone:520-431-2447
Mailing Address - Fax:
Practice Address - Street 1:115 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5201
Practice Address - Country:US
Practice Address - Phone:520-421-1120
Practice Address - Fax:520-421-2877
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-20399101Y00000X, 101YM0800X, 171400000X, 175F00000X, 175L00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath