Jennifer Dana Whaley Gundersen, LCSW, CASAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

079761-1 Issued in NY

Practice address

600 Johnson Ave Ste C13
Bohemia, NY 11716-2674

Phone

(631) 960-8575

Fax

(631) 315-1090

NPI assigned

Jan 12, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dynamic Pathways, LCSW, PLLC

  • Community/Behavioral Health Agency
  • Bohemia, NY
  • NPI 1548915804
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1881831949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 JOHNSON AVE STE C13",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117162674",
            "telephone_number": "631-960-8575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 JOHNSON AVE STE C13",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117162674",
            "telephone_number": "631-960-8575",
            "fax_number": "631-315-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHALEY GUNDERSEN",
        "first_name": "JENNIFER",
        "middle_name": "DANA",
        "credential": "LCSW, CASAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-12",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "077561",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "079761-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01781144",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Walton, LMSW
• Yening Wang, LPN
• Muhammad Waqas, PHARM D
• Mariam Waseem
• Tobi Rose Weinstein, RN
• Diana Marie Whelan
• William Francis Oleary LCSW PLLC
• Daniel Woods
• Frances A Wozniak, LCSW
• Maryann K Yarosz, RN

• Clinical Social Worker in Bohemia, NY
• Providers in Bohemia, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.