Provider Demographics
NPI:1205980489
Name:AMENDOLIA, ROSEMARIE DOROTHEA (PHD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:DOROTHEA
Last Name:AMENDOLIA
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 1:333 ALPLAUS AVE
Mailing Address - Street 2:
Mailing Address - City:ALPLAUS
Mailing Address - State:NY
Mailing Address - Zip Code:12008-1017
Mailing Address - Country:US
Mailing Address - Phone:518-399-7169
Mailing Address - Fax:518-346-0292
Practice Address - Street 1:801 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3407
Practice Address - Country:US
Practice Address - Phone:518-395-9187
Practice Address - Fax:518-346-0292
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01787677Medicaid
NY01787677Medicaid
NYBB7107Medicare ID - Type Unspecified