Healthcare Provider Details

I. General information

NPI: 1114050390
Provider Name (Legal Business Name): PSYCHOPHARMACOLOGY CONSULTANTS OF ALBANY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WOLF RD SUITE 5
COLONIE NY
12205-1244
US

IV. Provider business mailing address

110 WOLF RD SUITE 5
COLONIE NY
12205-1244
US

V. Phone/Fax

Practice location:
  • Phone: 518-458-2481
  • Fax: 518-489-4149
Mailing address:
  • Phone: 518-458-2481
  • Fax: 518-489-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number201439
License Number StateNY

VIII. Authorized Official

Name: KEVIN WAYNE GEORGE
Title or Position: OWNER
Credential: MD
Phone: 518-458-2481