Provider Demographics
NPI:1699829085
Name:DRYFOOS, JACQUELINE H (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:H
Last Name:DRYFOOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:DRYFOOS
Other - Last Name:GREENSPON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:775 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3554
Mailing Address - Country:US
Mailing Address - Phone:212-570-6577
Mailing Address - Fax:212-737-7837
Practice Address - Street 1:200 WEST 57
Practice Address - Street 2:SUITE 205
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-757-3490
Practice Address - Fax:212-737-7837
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO 16599 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPRO16599 1OtherNY STATE LICENSE #
NO8061Medicare ID - Type Unspecified