Healthcare Provider Details

I. General information

NPI: 1962445312
Provider Name (Legal Business Name): BRUCE FRANKLIN NELSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5320
  • Fax: 518-626-5407
Mailing address:
  • Phone: 518-626-5320
  • Fax: 518-626-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number10983
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: