Healthcare Provider Details

I. General information

NPI: 1972953628
Provider Name (Legal Business Name): KAREN DINUZZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MCLAWS CIR SUITE 1
WILLIAMSBURG VA
23185-5799
US

IV. Provider business mailing address

215 MCLAWS CIRCLE SUITE 1
WILLIAMSBURG VA
23185
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-6428
  • Fax: 757-345-6808
Mailing address:
  • Phone: 757-345-6428
  • Fax: 757-345-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0803000251
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: