Provider Demographics
NPI:1740639038
Name:ALTHEIM, GARY RICHARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:RICHARD
Last Name:ALTHEIM
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 1:199 KITCHAWAN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-2016
Mailing Address - Country:US
Mailing Address - Phone:917-533-6880
Mailing Address - Fax:
Practice Address - Street 1:199 KITCHAWAN RD
Practice Address - Street 2:
Practice Address - City:SOUTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10590-2016
Practice Address - Country:US
Practice Address - Phone:917-533-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012506-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical