Provider Demographics
NPI:1679706527
Name:HRYNYK, DOROTHY ROSE (LPC, CCMHC, MICA SPE)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ROSE
Last Name:HRYNYK
Suffix:
Gender:F
Credentials:LPC, CCMHC, MICA SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305
Mailing Address - Country:US
Mailing Address - Phone:201-451-5425
Mailing Address - Fax:201-451-7499
Practice Address - Street 1:75 HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305
Practice Address - Country:US
Practice Address - Phone:201-451-5425
Practice Address - Fax:201-451-7499
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ200361261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care