Healthcare Provider Details

I. General information

NPI: 1245351816
Provider Name (Legal Business Name): DEBRA J FRUCHTMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE CDPC
ALBANY NY
12208
US

IV. Provider business mailing address

23 S MAIN ST
VOORHEESVILLE NY
12186-9679
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6929
  • Fax:
Mailing address:
  • Phone: 518-469-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015911
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number015911-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number015911-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number015911-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number015911-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: