Provider Demographics
NPI:1902571813
Name:WIAND, DYLAN THOMAS (LMHC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:THOMAS
Last Name:WIAND
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GENUNG ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5206
Mailing Address - Country:US
Mailing Address - Phone:845-768-8995
Mailing Address - Fax:
Practice Address - Street 1:1124 ROUTE 94 STE 201
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7258
Practice Address - Country:US
Practice Address - Phone:845-787-1403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health