Provider Demographics
NPI:1881890226
Name:SANFORD MANOR PSYCHOLOGY, PC
Entity type:Organization
Organization Name:SANFORD MANOR PSYCHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:E
Authorized Official - Last Name:GORTHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-747-9407
Mailing Address - Street 1:260 E. SANFORD ST.
Mailing Address - Street 2:SANFORD MANOR PSYCHOLOGY, PC
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-792-0208
Mailing Address - Fax:
Practice Address - Street 1:260 SANFORD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2474
Practice Address - Country:US
Practice Address - Phone:518-792-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty