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General NPI Number Information
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NPI Number | 1649504754
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Entity Type | Organization
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Legal Business Name | HUDSON VALLEY DYNAMIC COUNSELING LCSW PC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 224 CHURCH ST
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-4282
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Country | US
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Telephone | 845-625-3181
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Fax |
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Provider Business Mailing Address
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Address Line | 3 DONNA DR
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-5611
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Country | US
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Telephone | 845-625-3181
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VASSELL G O'GILVIE
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Credential |
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Telephone | 845-625-3181
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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 | R047801
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License Number State | NY
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