MEDICARE: NORTHEAST PSYCHOLOGICAL ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1447817093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST PSYCHOLOGICAL ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	435 NEW KARNER RD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-3867
Country	:	US
Telephone Number	:	518-456-2060
Fax Number	:	518-456-2361

Provider Business Practice Location Address
First Line	:	435 NEW KARNER RD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-3867
Country	:	US
Telephone Number	:	518-456-2060
Fax Number	:	518-456-2361

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	DR. MICHAEL P DOBBIN
Credential	:	PSY.D.
Telephone Number	:	518-456-2060

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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