Provider Demographics
NPI:1376619296
Name:FIDANQUE, CLAUDIA S (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:S
Last Name:FIDANQUE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-3701
Mailing Address - Country:US
Mailing Address - Phone:845-424-8235
Mailing Address - Fax:845-424-4696
Practice Address - Street 1:1886 ROUTE 9
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-3701
Practice Address - Country:US
Practice Address - Phone:845-424-8235
Practice Address - Fax:845-424-4696
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14525-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical