Provider Demographics
NPI:1174653281
Name:KUNDERT, DEBORAH KING (PHD)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:KING
Last Name:KUNDERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROCKROSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1673
Mailing Address - Country:US
Mailing Address - Phone:518-436-3674
Mailing Address - Fax:518-464-5023
Practice Address - Street 1:1740 WESTERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4414
Practice Address - Country:US
Practice Address - Phone:518-464-5060
Practice Address - Fax:518-464-5023
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010764103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V889AOtherEMPIRE BCBS
000490284003OtherBSNENY
10016143OtherCDPHP