Provider Demographics
NPI:1568622785
Name:RIVER BEND PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:RIVER BEND PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-580-9863
Mailing Address - Street 1:23 CONVER DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9740
Mailing Address - Country:US
Mailing Address - Phone:518-580-9863
Mailing Address - Fax:
Practice Address - Street 1:23 CONVER DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9740
Practice Address - Country:US
Practice Address - Phone:518-580-9863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty