Basic Information
Provider Information
NPI: 1457321549
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAR-NAVON
FirstName: DONNA
MiddleName: DYER
NamePrefix:  
NameSuffix:  
Credential: PSY D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 15645
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891145645
CountryCode: US
TelephoneNumber: 7022408847
FaxNumber: 7022408790
Practice Location
Address1: 801 S RANCHO DR
Address2: F-2
City: LAS VEGAS
State: NV
PostalCode: 89106
CountryCode: US
TelephoneNumber: 7026763400
FaxNumber: 7024717246
Other Information
ProviderEnumerationDate: 01/23/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000XPYT050912NVY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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