Provider Demographics
NPI:1942793252
Name:DYNAMIC INTERVENTION, LLC
Entity Type:Organization
Organization Name:DYNAMIC INTERVENTION, LLC
Other - Org Name:DYNAMIC INTERVENTION, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:845-702-1042
Mailing Address - Street 1:3 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-2301
Mailing Address - Country:US
Mailing Address - Phone:845-702-1042
Mailing Address - Fax:845-709-8434
Practice Address - Street 1:3 MARKET ST
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-2301
Practice Address - Country:US
Practice Address - Phone:845-702-1042
Practice Address - Fax:845-709-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0564891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02869556Medicaid