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General NPI Number Information
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NPI Number | 1699395426
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Entity Type | Individual
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Provider Name | JACKLYN DWYER
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Gender | Female
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 22 OVAL SUITE 100
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City | PLATTSBURGH
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State | NY
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Zip | 12903
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Country | US
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Telephone | 518-563-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 2598 LOWELL AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32254-3211
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Country | US
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Telephone | 914-620-5279
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 104638
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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