Provider Demographics
NPI:1922764273
Name:RYNKEWICZ, DOUGLAS EDMUND (MA, EDS, LAC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EDMUND
Last Name:RYNKEWICZ
Suffix:
Gender:M
Credentials:MA, EDS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 HARBOUR DR APT B
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-6120
Mailing Address - Country:US
Mailing Address - Phone:609-658-3426
Mailing Address - Fax:
Practice Address - Street 1:795 WOODLANE RD STE 300
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3832
Practice Address - Country:US
Practice Address - Phone:609-267-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1094746101YS0200X
NJ37AC00440200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool