Provider Demographics
NPI:1558383851
Name:PANOZZO, DWIGHT DAVID (LCSW)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:DAVID
Last Name:PANOZZO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WERIMUS LN
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8240
Mailing Address - Country:US
Mailing Address - Phone:201-476-1816
Mailing Address - Fax:201-307-1470
Practice Address - Street 1:60 WERIMUS LN
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8240
Practice Address - Country:US
Practice Address - Phone:201-476-1816
Practice Address - Fax:201-307-1470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000947001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA686135Medicare ID - Type Unspecified