Provider Demographics
NPI:1629581277
Name:ALBACH, CECILY ANN
Entity Type:Individual
Prefix:MRS
First Name:CECILY
Middle Name:ANN
Last Name:ALBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CECILY
Other - Middle Name:ANN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 BURNING HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-9651
Mailing Address - Country:US
Mailing Address - Phone:315-510-3653
Mailing Address - Fax:
Practice Address - Street 1:159 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-342-9575
Practice Address - Fax:315-342-7664
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool