Healthcare Provider Details

I. General information

NPI: 1679583785
Provider Name (Legal Business Name): THOMAS R. YANE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S MONROE AVE
COVINGTON VA
24426-1635
US

IV. Provider business mailing address

311 S MONROE AVE
COVINGTON VA
24426-1635
US

V. Phone/Fax

Practice location:
  • Phone: 540-965-2100
  • Fax: 540-965-2105
Mailing address:
  • Phone: 540-965-2100
  • Fax: 540-965-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003310
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: