Provider Demographics
NPI:1598144438
Name:KRAWCZYK, ROSS KARIM (PHD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:KARIM
Last Name:KRAWCZYK
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 1:260 WASHINGTON AVENUE EXT
Mailing Address - Street 2:CORPORATE PLAZA #101
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-6326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 WASHINGTON AVENUE EXT
Practice Address - Street 2:CORPORATE PLAZA #101
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-6326
Practice Address - Country:US
Practice Address - Phone:518-218-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021162-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist