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NPI Code Detail

MEDICARE: RICHARD DWORK LMSW

MEDICARE: RICHARD DWORK LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker082108NY

General Provider Information

NPI Number : 1265073829
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD DWORK LMSW
Provider Business Mailing Address
First Line : PO BOX 653
Second Line :
City : LEVITTOWN
State : NY
Zip : 11756-0653
Country : US
Telephone Number : 516-567-6781
Fax Number :
Provider Business Practice Location Address
First Line : 201 DIXON AVE
Second Line :
City : AMITYVILLE
State : NY
Zip : 11701-2994
Country : US
Telephone Number : 631-691-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2019
Last Update Date : 10/04/2019

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