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General NPI Number Information
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NPI Number | 1033989546
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Entity Type | Individual
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Provider Name | JOHN GAY WOOLLEY DSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 114 5TH AVE FL 2
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City | NEW YORK
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State | NY
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Zip | 10011-5611
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Country | US
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Telephone | 347-569-3733
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Fax |
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Provider Business Mailing Address
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Address Line | 131 MORICHES AVE
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City | MASTIC
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State | NY
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Zip | 11950-3827
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Country | US
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Telephone | 347-567-3733
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 096796
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License Number State | NY
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