Provider Demographics
NPI:1538688924
Name:PRESENCE PSYCHOLOGY, LMSW, PT, OT AND SLP SERVICES, PLLC
Entity Type:Organization
Organization Name:PRESENCE PSYCHOLOGY, LMSW, PT, OT AND SLP SERVICES, PLLC
Other - Org Name:PRESENCE DEVELOPMENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEALY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:315-515-5183
Mailing Address - Street 1:115 FALL ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1498
Mailing Address - Country:US
Mailing Address - Phone:315-515-5183
Mailing Address - Fax:315-515-5194
Practice Address - Street 1:115 FALL ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1498
Practice Address - Country:US
Practice Address - Phone:315-515-5183
Practice Address - Fax:315-515-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-17
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020001-1103TM1800X
NY020699-1225100000X
225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05438899Medicaid