Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813000886 | VA |
NPI | 1033611363 |
---|---|
Provider Name | Mr. William Mcenroe |
First Address | Newport News, VA 23601-2309 |
Second Address | Newport News, VA 23601-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2018 |
Last Update Date | 02/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0813000886 | (05) | VA |