Healthcare Provider Details

I. General information

NPI: 1164827317
Provider Name (Legal Business Name): FERNDALE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SULLIVAN AVE SUITE 2-5
FERNDALE NY
12734-4315
US

IV. Provider business mailing address

111 SULLIVAN AVE SUITE 2-5
FERNDALE NY
12734-4315
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-6222
  • Fax: 845-292-6220
Mailing address:
  • Phone: 845-292-6222
  • Fax: 845-292-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL E SCHWARTZ
Title or Position: OWNER
Credential: PSYD
Phone: 845-292-6222