Individual
TIMOTHY RYAN VANDUYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC-T, LPN
Contact information
Practice address
1519 NYE RD, LYONS, NY 14489-9133
(315) 946-5722
(315) 946-7079
Mailing address
1519 NYE RD, LYONS, NY 14489-9133
(315) 946-5722
(315) 946-7079
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25559
NY
Other
Enumeration date
05/03/2011
Last updated
05/03/2011
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