Provider Demographics
NPI:1528378692
Name:ADIRONDACK CROSS ROADS PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:ADIRONDACK CROSS ROADS PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORIGINAL MANAGER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SCHULZE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:518-798-2088
Mailing Address - Street 1:123 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2133
Mailing Address - Country:US
Mailing Address - Phone:518-798-2088
Mailing Address - Fax:518-798-2088
Practice Address - Street 1:123 DIXON RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2133
Practice Address - Country:US
Practice Address - Phone:518-798-2088
Practice Address - Fax:518-798-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY137679OtherVALUE OPTIONS
NYVE9702OtherEMPIRE BLUE CROSS BLUE SHIELD
NY200207781OtherCDPHP
NY41202OtherMVP
NY01675901Medicaid
NY000405218002OtherBLUE SHIELD OF NORTHEASTERN NEW YORK
NY137679OtherVALUE OPTIONS