Healthcare Provider Details

I. General information

NPI: 1497799530
Provider Name (Legal Business Name): RONALD BASSMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1674 WESTERN AVE
ALBANY NY
12203-4218
US

IV. Provider business mailing address

1674 WESTERN AVE
ALBANY NY
12203-4218
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-1820
  • Fax: 518-456-1820
Mailing address:
  • Phone: 518-456-1820
  • Fax: 518-456-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number012672-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: