Healthcare Provider Details

I. General information

NPI: 1447817093
Provider Name (Legal Business Name): NORTHEAST PSYCHOLOGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 NEW KARNER RD
ALBANY NY
12205-3867
US

IV. Provider business mailing address

435 NEW KARNER RD
ALBANY NY
12205-3867
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-2060
  • Fax: 518-456-2361
Mailing address:
  • Phone: 518-456-2060
  • Fax: 518-456-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL P DOBBIN
Title or Position: SOLE OWNER
Credential: PSY.D.
Phone: 518-456-2060