Provider Demographics
NPI:1891912739
Name:BLANK, WILLIAM ALAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALAN
Last Name:BLANK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOLLOW TREE RIDGE RD
Mailing Address - Street 2:APARTMENT 403
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5045
Mailing Address - Country:US
Mailing Address - Phone:203-341-2468
Mailing Address - Fax:
Practice Address - Street 1:137 HOLLOW TREE RIDGE RD
Practice Address - Street 2:APARTMENT 403
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5045
Practice Address - Country:US
Practice Address - Phone:203-341-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015771-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist