Provider Demographics
NPI:1982971941
Name:PLATTSBURGH STATE UNIVERSITY
Entity Type:Organization
Organization Name:PLATTSBURGH STATE UNIVERSITY
Other - Org Name:NORTH COUNTRY REGIONAL TBI CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SPONSORED RESEARCH
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-564-2155
Mailing Address - Street 1:101 BROAD ST
Mailing Address - Street 2:KEHOE 815
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2637
Mailing Address - Country:US
Mailing Address - Phone:518-564-2155
Mailing Address - Fax:
Practice Address - Street 1:101 BROAD ST
Practice Address - Street 2:BEAMONT 404
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2637
Practice Address - Country:US
Practice Address - Phone:518-564-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE UNIVERSITY OF NEW YORK COLLEGE AT PLATTSBURGH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013297103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty