Provider Demographics
NPI:1417031568
Name:BATES, DEBBIE S (PHD)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:S
Last Name:BATES
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 1:5800 HERITAGE LANDING DR STE G2
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9378
Mailing Address - Country:US
Mailing Address - Phone:315-559-2375
Mailing Address - Fax:
Practice Address - Street 1:5800 HERITAGE LANDING DR STE G2
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9378
Practice Address - Country:US
Practice Address - Phone:315-559-2375
Practice Address - Fax:313-883-8311
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012732-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB4383Medicare ID - Type Unspecified