Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810000926 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810000926 | VA |
NPI | 1003809500 |
---|---|
Provider Name | William J Duane |
First Address | Chesapeake, VA 23321-5525 |
Second Address | Chesapeake, VA 23321-5525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 07/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007799187 | (05) | VA |
027830 | ANTHEM (01) | VA |
080704 | SENTARA (01) | VA |