Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 090313 | NY |
N | 103T00000X | Psychologist | 090313 | NY |
Y | 104100000X | Social Worker | 090313 | NY |
NPI | 1003287665 |
---|---|
Provider Name | Dr. Dwayne Poole-Seymour |
First Address | Brooklyn, NY 11203-2617 |
Second Address | New York, NY 10027-3739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2015 |
Last Update Date | 08/10/2015 |