Provider Demographics
NPI:1346505161
Name:VANDUYNE, LIONEL VINCENT JR (MS ED)
Entity Type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:VINCENT
Last Name:VANDUYNE
Suffix:JR
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SAINT NICHOLAS TER APT 26
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2834
Mailing Address - Country:US
Mailing Address - Phone:917-539-5920
Mailing Address - Fax:
Practice Address - Street 1:25 SAINT NICHOLAS TER APT 26
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-2834
Practice Address - Country:US
Practice Address - Phone:917-539-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XOtherTHERAPIST