Provider Demographics
NPI:1679638944
Name:DUNNER, GARY J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:J
Last Name:DUNNER
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 1:2105 W GENESEE ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1656
Mailing Address - Country:US
Mailing Address - Phone:315-488-1884
Mailing Address - Fax:315-488-1884
Practice Address - Street 1:2105 W GENESEE ST
Practice Address - Street 2:SUITE 113
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1656
Practice Address - Country:US
Practice Address - Phone:315-488-1884
Practice Address - Fax:315-488-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026113-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical