Provider Demographics
NPI:1740397488
Name:LANDIS, RHONDA K B (PHD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:K B
Last Name:LANDIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 BURDETT AVE
Mailing Address - Street 2:BEHAVIORAL HEALTH DEPT
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2466
Mailing Address - Country:US
Mailing Address - Phone:518-271-3300
Mailing Address - Fax:
Practice Address - Street 1:1A PINE WEST PLZ
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5557
Practice Address - Country:US
Practice Address - Phone:518-862-1665
Practice Address - Fax:518-862-1668
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013626103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S38276Medicare UPIN