Provider Demographics
NPI:1164017893
Name:BRONDER, CRAIG JOSEPH (MA, MHC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:JOSEPH
Last Name:BRONDER
Suffix:
Gender:M
Credentials:MA, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AMY KAY PKWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6444
Mailing Address - Country:US
Mailing Address - Phone:845-331-1261
Mailing Address - Fax:
Practice Address - Street 1:1 AMY KAY PKWY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6444
Practice Address - Country:US
Practice Address - Phone:845-331-1261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP106767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health