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General NPI Number Information
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NPI Number | 1548915804
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Entity Type | Organization
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Legal Business Name | DYNAMIC PATHWAYS, LCSW, PLLC
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 600 JOHNSON AVE STE C13
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City | BOHEMIA
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State | NY
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Zip | 11716-2674
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Country | US
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Telephone | 631-960-8575
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Fax | 631-315-1090
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Provider Business Mailing Address
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Address Line | 600 JOHNSON AVE STE C13
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City | BOHEMIA
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State | NY
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Zip | 11716-2674
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Country | US
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Telephone | 163-196-0857
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER WHALEY GUNDERSEN
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Credential | LCSW
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Telephone | 631-960-8575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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