Provider Demographics
NPI:1336337781
Name:MARVIN J, FINE
Entity Type:Organization
Organization Name:MARVIN J, FINE
Other - Org Name:AFFILIATED PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-783-1051
Mailing Address - Street 1:70 NOTT ROAD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148
Mailing Address - Country:US
Mailing Address - Phone:518-783-1051
Mailing Address - Fax:518-783-1051
Practice Address - Street 1:623 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4031
Practice Address - Country:US
Practice Address - Phone:518-783-1051
Practice Address - Fax:518-783-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010014-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01698604Medicaid
NY01587604Medicaid
NY01698604Medicaid
NYAA1596Medicare UPIN
NY01587604Medicaid