MEDICARE: YORK PSYCHOLOGY, P.L.L.C.

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	103TC0700X	Clinical Psychologist	0184501	NY

General Provider Information

NPI Number	:	1689095374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YORK PSYCHOLOGY, P.L.L.C.

Provider Business Mailing Address
First Line	:	66 MONTGOMERY ST
Second Line	:
City	:	CANAJOHARIE
State	:	NY
Zip	:	13317-1212
Country	:	US
Telephone Number	:	518-673-8060
Fax Number	:	518-673-8061

Provider Business Practice Location Address
First Line	:	66 MONTGOMERY ST
Second Line	:
City	:	CANAJOHARIE
State	:	NY
Zip	:	13317-1212
Country	:	US
Telephone Number	:	518-673-8060
Fax Number	:	518-673-8061

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	DR. JANINE YORK
Credential	:	PSY.D.
Telephone Number	:	518-673-8060

Provider Enumeration Date	:	12/23/2013
Last Update Date	:	12/23/2013

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