Provider Demographics
NPI:1477370534
Name:DANTZLER, JUSTIN ERROL (LMHC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ERROL
Last Name:DANTZLER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2829
Mailing Address - Country:US
Mailing Address - Phone:516-749-8224
Mailing Address - Fax:
Practice Address - Street 1:1554 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2829
Practice Address - Country:US
Practice Address - Phone:516-749-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015074101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty