Provider Demographics
NPI:1457409583
Name:CEDERBAUM, MARK K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:CEDERBAUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 COUNTY ROUTE 76
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-2741
Mailing Address - Country:US
Mailing Address - Phone:518-956-3465
Mailing Address - Fax:
Practice Address - Street 1:3 LEAR JET LN
Practice Address - Street 2:BEHAVIORAL HEALTH SPECIALISTS PLLC, SUITE 105
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2314
Practice Address - Country:US
Practice Address - Phone:518-785-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016544-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical