| NPI | 1508195421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND ALAN BODENSIECK Owner 518-383-7793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010453) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2009-12-24 |