Healthcare Provider Details

I. General information

NPI: 1316488067
Provider Name (Legal Business Name): W. MACK BARTELS, PSY.D. AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 ROUTE 17M
HARRIMAN NY
10926-3329
US

IV. Provider business mailing address

144 ROUTE 17M
HARRIMAN NY
10926-3329
US

V. Phone/Fax

Practice location:
  • Phone: 845-395-0066
  • Fax: 888-894-4861
Mailing address:
  • Phone: 845-395-0066
  • Fax: 888-894-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number016948-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number043475
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number022780-R
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM BARTELS
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 914-805-3094