Healthcare Provider Details

I. General information

NPI: 1124572227
Provider Name (Legal Business Name): ALBANY PSYCHOLOGICAL SERVICES FOR EATING DISORDERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WASHINGTON ST STE 202
POUGHKEEPSIE NY
12601-8112
US

IV. Provider business mailing address

207 WASHINGTON STREET SUITE 202
POUGHKEEPSIE NY
12601-8112
US

V. Phone/Fax

Practice location:
  • Phone: 518-218-1188
  • Fax: 518-218-1988
Mailing address:
  • Phone: 518-218-1188
  • Fax: 518-218-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNY

VIII. Authorized Official

Name: JULIE N MORISON
Title or Position: OWNER/ DIRECTOR
Credential: PHD
Phone: 518-218-1188