Healthcare Provider Details

I. General information

NPI: 1235243080
Provider Name (Legal Business Name): STEVE DAGIRMANJIAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N FRONT ST
KINGSTON NY
12401-3729
US

IV. Provider business mailing address

PO BOX 3901
KINGSTON NY
12402-3901
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-5450
  • Fax: 845-338-0949
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007549-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: