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General NPI Number Information
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NPI Number | 1619719424
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Entity Type | Individual
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Provider Name | DYLAN WOLOSZCZUK LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/11/2024
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 6735 112TH ST
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City | FOREST HILLS
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State | NY
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Zip | 11375-2349
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Country | US
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Telephone | 718-362-0740
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Fax |
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Provider Business Mailing Address
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Address Line | 3422 29TH ST APT 2
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City | ASTORIA
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State | NY
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Zip | 11106-3569
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Country | US
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Telephone | 570-589-9187
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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 | 100826
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License Number State | NY
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