| NPI | 1275751133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONDA E NEVIN Office Manager 518-456-2060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 0114752) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 0111791) |
| 1041C0700X Social Worker, Clinical (Licence: NY 0697551) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 056814) | |
| 1041C0700X Social Worker, Clinical (Licence: NY R038168) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |