Provider Demographics
NPI:1831246792
Name:PSYCHOLOGICAL ASSOCIATES OF NORTHEASTERN NEW YORK PC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF NORTHEASTERN NEW YORK PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOMENICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-798-4056
Mailing Address - Street 1:551 BAY RD.
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1280
Mailing Address - Country:US
Mailing Address - Phone:518-798-4056
Mailing Address - Fax:518-798-4255
Practice Address - Street 1:551 BAY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1280
Practice Address - Country:US
Practice Address - Phone:518-798-4056
Practice Address - Fax:518-798-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty