Provider Demographics
NPI:1437690765
Name:AMADOR, XAVIER (PHD)
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:
Last Name:AMADOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:PECONIC
Mailing Address - State:NY
Mailing Address - Zip Code:11958-1616
Mailing Address - Country:US
Mailing Address - Phone:516-578-1864
Mailing Address - Fax:646-304-4888
Practice Address - Street 1:1150 SMITH RD
Practice Address - Street 2:
Practice Address - City:PECONIC
Practice Address - State:NY
Practice Address - Zip Code:11958-1616
Practice Address - Country:US
Practice Address - Phone:516-578-1864
Practice Address - Fax:646-304-4888
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010154103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010154OtherPSYCHOLOGIST LICENSE