Provider Demographics
NPI:1679583785
Name:YANE, THOMAS R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:YANE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1635
Mailing Address - Country:US
Mailing Address - Phone:540-965-2100
Mailing Address - Fax:540-965-2105
Practice Address - Street 1:311 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1635
Practice Address - Country:US
Practice Address - Phone:540-965-2100
Practice Address - Fax:540-965-2105
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040033101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA214163OtherANTHEM
VA541217983OtherTAX ID
VA004945034Medicaid
VA214163OtherANTHEM
VA541217983OtherTAX ID