| Doctor Name: | MR. DOUGLAS J VINCENT |
| NPI Number: | 1922209485 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | R053428-1 |
| Business Practice Address: | 2023 Route 9 Round Lake, NY - 121511701 |
| Business Phone Number: | 5188775301 |
| Business Fax Number: | 5188775302 |
| Mailing Address: | Po Box 723, CLIFTON PARK |
| State: | NY |
| Postal Code: | 120650723 |
| Phone Number: | 5189284315 |
| Fax Number: | 5188775302 |
| NPI Enumeration Date: | 05/30/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R053428-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |