Provider Demographics
NPI:1881084820
Name:PSYCHIATRY FACULTY PRACTICE, INC.
Entity type:Organization
Organization Name:PSYCHIATRY FACULTY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE PLAN ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SVOBODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-464-3119
Mailing Address - Street 1:713 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2305
Mailing Address - Country:US
Mailing Address - Phone:315-464-3119
Mailing Address - Fax:315-464-3282
Practice Address - Street 1:713 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2305
Practice Address - Country:US
Practice Address - Phone:315-464-3119
Practice Address - Fax:315-464-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00570654Medicaid
56538AMedicare PIN