Healthcare Provider Details

I. General information

NPI: 1679940696
Provider Name (Legal Business Name): TAYLOR CONCORDIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 FRANKLIN ST FLOOR 2
SCHENECTADY NY
12305-2011
US

IV. Provider business mailing address

593 BENDING BOUGH DR
WEBSTER NY
14580-8981
US

V. Phone/Fax

Practice location:
  • Phone: 518-381-8911
  • Fax:
Mailing address:
  • Phone: 585-967-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP99188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: