Provider Demographics
NPI:1629571195
Name:HARRY, DWAINE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DWAINE
Middle Name:
Last Name:HARRY
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 1:16317 130TH AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3063
Mailing Address - Country:US
Mailing Address - Phone:516-849-1001
Mailing Address - Fax:
Practice Address - Street 1:8974 162ND ST STE 5
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5012
Practice Address - Country:US
Practice Address - Phone:718-206-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0972761041C0700X
NY098303261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical