Healthcare Provider Details

I. General information

NPI: 1528174505
Provider Name (Legal Business Name): CYNTHIA ANN BOBSEINE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 THOMAS RD
OLD CHATHAM NY
12136-3514
US

IV. Provider business mailing address

231 THOMAS RD
OLD CHATHAM NY
12136-3514
US

V. Phone/Fax

Practice location:
  • Phone: 518-392-3360
  • Fax: 518-482-4147
Mailing address:
  • Phone: 518-392-3639
  • Fax: 518-482-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number011453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: