Provider Demographics
NPI:1780606988
Name:PERTCHIK, KEVIN C (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:PERTCHIK
Suffix:
Gender:M
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:ONE WEST AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-587-0499
Mailing Address - Fax:518-587-0536
Practice Address - Street 1:ONE WEST AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-587-0499
Practice Address - Fax:518-587-0536
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015853-1103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02525693Medicaid
NYIA0931Medicare PIN
NY02525693Medicaid