Active NPI
Willis T Van Dyne, PSY D
- Clinical Psychologist
- Troy, NY
National Provider Identifier
1023123767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 006790
- Practice address
- 41 2ND St
Troy, NY 12180-3928 - Phone
- (518) 272-0506
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 006790 | NY | Primary |
Addresses
Primary practice location
41 2ND St
Troy, NY 12180-3928
Mailing address
41 2ND St
Troy, NY 12180-3928
Phone (518) 272-0506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006790-1 | NY | MD | Mental Health Counselor |
| 006790 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208217600000",
"number": "1023123767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 2ND ST",
"city": "TROY",
"state": "NY",
"postal_code": "121803928",
"telephone_number": "518-272-0506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 2ND ST",
"city": "TROY",
"state": "NY",
"postal_code": "121803928",
"telephone_number": "518-272-0506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DYNE",
"first_name": "WILLIS",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "PSY D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2008-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "006790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.