Provider Demographics
NPI:1801876990
Name:DUMMER, VINCENT BERNARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:BERNARD
Last Name:DUMMER
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 1:436 W SECOND ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1040
Mailing Address - Country:US
Mailing Address - Phone:859-231-7137
Mailing Address - Fax:
Practice Address - Street 1:436 W SECOND ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1040
Practice Address - Country:US
Practice Address - Phone:859-231-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0534103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0002060Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
KY0245638Medicare ID - Type Unspecified
KYR38189Medicare UPIN