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Individual
R KEVIN DOUGLAS
Active
Individual
R KEVIN DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW CASAC
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
73 080102
NY
Other
Enumeration date
01/20/2013
Last updated
01/20/2013
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