Provider Demographics
NPI:1962612838
Name:GWIN, DAVID KELLY (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KELLY
Last Name:GWIN
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 95TH ST APT 19M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4091
Mailing Address - Country:US
Mailing Address - Phone:212-464-8300
Mailing Address - Fax:
Practice Address - Street 1:205 E 95TH ST APT 19M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4091
Practice Address - Country:US
Practice Address - Phone:212-464-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health