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General NPI Number Information
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NPI Number | 1003287665
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Entity Type | Individual
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Provider Name | DWAYNE POOLE-SEYMOUR PHD
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Gender | Male
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 154 W 127TH ST
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City | NEW YORK
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State | NY
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Zip | 10027-3739
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Country | US
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Telephone | 212-749-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 931 LENOX RD
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City | BROOKLYN
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State | NY
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Zip | 11203-2617
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Country | US
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Telephone | 718-551-6723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 090313
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 090313
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 090313
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License Number State | NY
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