Healthcare Provider Details

I. General information

NPI: 1144886201
Provider Name (Legal Business Name): SPHERE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 GENESEE ST FL 2
UTICA NY
13502-5814
US

IV. Provider business mailing address

2520 GENESEE ST FL 2
UTICA NY
13502-5814
US

V. Phone/Fax

Practice location:
  • Phone: 315-941-5170
  • Fax: 315-533-4377
Mailing address:
  • Phone: 315-941-5170
  • Fax: 315-533-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: HEATHER LESTER
Title or Position: SOLE PROPRIETOR
Credential: PHD
Phone: 315-941-5170