=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841367331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM JOSEPH DUNGAN LCSW LICENSED CLINIC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 218 OHIO STREET
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-451-8514
-----------------------------------------------------
Fax | 606-451-8514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 218 OHIO STREET
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-451-8514
-----------------------------------------------------
Fax | 606-451-8514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0077
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------