Healthcare Provider Details

I. General information

NPI: 1215382148
Provider Name (Legal Business Name): CAPITAL DISTRICT PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

IV. Provider business mailing address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6400
  • Fax: 518-549-6426
Mailing address:
  • Phone: 518-549-6400
  • Fax: 518-549-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberRO439421
License Number StateNY

VIII. Authorized Official

Name: MR. WILLIAM J DICKSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW-R
Phone: 518-549-6825