Provider Demographics
NPI:1063106615
Name:DYER, ADRIAN DUDLEY (PHD- CANIDATE)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:DUDLEY
Last Name:DYER
Suffix:
Gender:M
Credentials:PHD- CANIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 PUTNAM AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-4220
Mailing Address - Country:US
Mailing Address - Phone:347-348-8534
Mailing Address - Fax:
Practice Address - Street 1:1027 PUTNAM AVE APT 3C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-4220
Practice Address - Country:US
Practice Address - Phone:347-348-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty