Provider Demographics
NPI:1861506248
Name:CANAR, WILLIAM JEFFREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:CANAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HINES VA, SCI CENTER, BLDG 128
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-5000
Mailing Address - Country:US
Mailing Address - Phone:708-202-7415
Mailing Address - Fax:
Practice Address - Street 1:HINES VA, SCI CENTER, BLDG 128
Practice Address - Street 2:HINES VA, SCI CENTER, BLDG 128
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5000
Practice Address - Country:US
Practice Address - Phone:708-202-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71006618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical