Provider Demographics
NPI:1679674782
Name:VAN ORMAN, WAYNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:VAN ORMAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 STOW ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2400
Mailing Address - Country:US
Mailing Address - Phone:978-371-7338
Mailing Address - Fax:
Practice Address - Street 1:58 STOW ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2400
Practice Address - Country:US
Practice Address - Phone:978-371-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7250103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling