Healthcare Provider Details

I. General information

NPI: 1225134190
Provider Name (Legal Business Name): MINA DUNNAM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WELLS ST SUITE 103
SARATOGA SPRINGS NY
12866-1200
US

IV. Provider business mailing address

7 WELLS ST SUITE 103
SARATOGA SPRINGS NY
12866-1200
US

V. Phone/Fax

Practice location:
  • Phone: 518-581-7260
  • Fax: 518-633-1218
Mailing address:
  • Phone: 518-581-7260
  • Fax: 518-633-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number008859
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number008859
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number008859
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number008859
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number008859
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number008859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: