Healthcare Provider Details

I. General information

NPI: 1457138505
Provider Name (Legal Business Name): LEE GEDDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 10/07/2023
Certification Date: 10/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PINE WEST PLZ STE 508
ALBANY NY
12205-5587
US

IV. Provider business mailing address

2 COLLEEN DR
LOUDONVILLE NY
12211-2202
US

V. Phone/Fax

Practice location:
  • Phone: 518-339-1633
  • Fax:
Mailing address:
  • Phone: 518-339-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: