Healthcare Provider Details

I. General information

NPI: 1417031568
Provider Name (Legal Business Name): DEBBIE S BATES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 E BRIGHTON AVE
SYRACUSE NY
13205-2542
US

IV. Provider business mailing address

5800 HERITAGE LANDING DR STE G2
EAST SYRACUSE NY
13057-9378
US

V. Phone/Fax

Practice location:
  • Phone: 315-559-2375
  • Fax: 313-883-8311
Mailing address:
  • Phone: 315-559-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number012732-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: