Provider Demographics
NPI:1467022418
Name:KLUBER, DYLAN THOMAS (LMSW)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:THOMAS
Last Name:KLUBER
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 1:9 BATES LN
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-1726
Mailing Address - Country:US
Mailing Address - Phone:631-603-5195
Mailing Address - Fax:
Practice Address - Street 1:401 MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3560
Practice Address - Country:US
Practice Address - Phone:631-446-1950
Practice Address - Fax:631-446-1952
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112218104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker