Dr. Willis T Van Dyne, Psy D
Psychologist, Clinical in Troy, NY. Individual provider (NPI-1).
NPI number1023123767
StatusActive
Last updated in NPPESApr 15, 2008
Details
- NPI
- 1023123767
- Entity type
- Individual (NPI-1)
- Name
- Dr. Willis T Van Dyne
- Credential
- Psy D
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 21, 2006
- Last updated
- Apr 15, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | 006790 | NY | Yes |
Practice location
41 2nd StTroy, NY 12180-3928
Phone 518-272-0506
Mailing address
41 2nd StTroy, NY 12180-3928
Phone 518-272-0506
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