Provider Demographics
NPI:1922749134
Name:DR. ADAM GORMAN, PSY.D., PLLC
Entity Type:Organization
Organization Name:DR. ADAM GORMAN, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL PSYCHOLOGIS
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:518-434-1799
Mailing Address - Street 1:4 PALISADES DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1443
Mailing Address - Country:US
Mailing Address - Phone:518-434-1799
Mailing Address - Fax:518-434-1123
Practice Address - Street 1:4 PALISADES DR STE 205
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1443
Practice Address - Country:US
Practice Address - Phone:518-434-1799
Practice Address - Fax:518-434-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548492655OtherNPI