Provider Demographics
NPI:1679140834
Name:BARTLETT, WILLIAM WHALEN JR (AS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WHALEN
Last Name:BARTLETT
Suffix:JR
Gender:M
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1037
Mailing Address - Country:US
Mailing Address - Phone:845-705-7802
Mailing Address - Fax:
Practice Address - Street 1:90 STATE ST STE 700
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1707
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:631-385-7795
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician