Healthcare Provider Details

I. General information

NPI: 1003787854
Provider Name (Legal Business Name): DANIEL DYNES LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 JOURNAL SQ STE 505
JERSEY CITY NJ
07306-4105
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 201-632-5554
  • Fax:
Mailing address:
  • Phone: 732-982-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL07134300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: