Provider Demographics
NPI:1871632489
Name:WILLIAM, DOUGLAS LON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LON
Last Name:WILLIAM
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 1:30 FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2312
Mailing Address - Country:US
Mailing Address - Phone:516-931-0752
Mailing Address - Fax:
Practice Address - Street 1:30 FLOWER LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2312
Practice Address - Country:US
Practice Address - Phone:516-931-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6159103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent