Provider Demographics
NPI:1922109578
Name:PSYCHOLOGICAL HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-605-4986
Mailing Address - Street 1:3300 JAMES ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2387
Mailing Address - Country:US
Mailing Address - Phone:315-422-0300
Mailing Address - Fax:315-479-8455
Practice Address - Street 1:3300 JAMES ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2387
Practice Address - Country:US
Practice Address - Phone:315-422-0300
Practice Address - Fax:315-479-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01715746Medicaid
NY01715746Medicaid