Provider Demographics
NPI:1154545325
Name:GWYN, RODNEY ALEXANDER (LCSW)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:ALEXANDER
Last Name:GWYN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:355 WEST 51ST STREET
Mailing Address - Street 2:#51
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-245-3399
Mailing Address - Fax:
Practice Address - Street 1:333 ATLANTIC AVENUE
Practice Address - Street 2:ST VINCENTS MENTAL HEALTH
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-522-6011
Practice Address - Fax:718-522-1560
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0692771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical