Provider Demographics
NPI:1770154189
Name:DYNAMIC INSIGHT LLC
Entity type:Organization
Organization Name:DYNAMIC INSIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGMON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW
Authorized Official - Phone:310-435-3463
Mailing Address - Street 1:2911 S WOODSTOCK ST APT D
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-4001
Mailing Address - Country:US
Mailing Address - Phone:310-435-3463
Mailing Address - Fax:
Practice Address - Street 1:2911 S WOODSTOCK ST APT D
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-4001
Practice Address - Country:US
Practice Address - Phone:310-435-3463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NPIOther1689079014