Healthcare Provider Details

I. General information

NPI: 1013781871
Provider Name (Legal Business Name): PSYCHIATRY SERVICES OF NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 JAMES ST STE 100
SYRACUSE NY
13206-2392
US

IV. Provider business mailing address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

V. Phone/Fax

Practice location:
  • Phone: 315-422-0300
  • Fax:
Mailing address:
  • Phone: 952-246-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA STACEY BRONSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 978-222-3121