Provider Demographics
NPI:1487805446
Name:DWYER, DOREEN KELLY (LCSW)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:KELLY
Last Name:DWYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 HIDDEN LAKE DR
Mailing Address - Street 2:UNIT 7
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-7739
Mailing Address - Country:US
Mailing Address - Phone:845-489-3514
Mailing Address - Fax:
Practice Address - Street 1:5867 WHITAKER RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-2963
Practice Address - Country:US
Practice Address - Phone:239-774-2904
Practice Address - Fax:239-774-1438
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL127701041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)