Healthcare Provider Details

I. General information

NPI: 1841304284
Provider Name (Legal Business Name): NYSOMH/CAPITAL DISTRICT PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CENTRAL AVE
ALBANY NY
12206-2937
US

IV. Provider business mailing address

175 CENTRAL AVE
ALBANY NY
12206-2937
US

V. Phone/Fax

Practice location:
  • Phone: 518-436-4462
  • Fax: 518-436-4558
Mailing address:
  • Phone: 518-436-4462
  • Fax: 518-436-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number400371
License Number StateNY

VIII. Authorized Official

Name: SHIRLEY STALEY
Title or Position: DIRECTOR OF NURSING
Credential: MS NPP
Phone: 518-447-9611