Provider Demographics
NPI:1689077216
Name:DWYER, DARRELL
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:
Last Name:DWYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ROCKY LN
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-3811
Mailing Address - Country:US
Mailing Address - Phone:914-391-4503
Mailing Address - Fax:845-424-3586
Practice Address - Street 1:22 ROCKY LN
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-3811
Practice Address - Country:US
Practice Address - Phone:914-391-4503
Practice Address - Fax:845-424-3586
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003614-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health