Provider Demographics
NPI:1871682401
Name:MYERS, DWIGHT S (LCSW)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:S
Last Name:MYERS
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 1:1401 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5321
Mailing Address - Country:US
Mailing Address - Phone:607-379-3050
Mailing Address - Fax:
Practice Address - Street 1:1401 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5321
Practice Address - Country:US
Practice Address - Phone:607-379-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28878101YM0800X
NYR0598381103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01079267Medicaid
NY01079267Medicaid
NYBB7737Medicare ID - Type Unspecified