Healthcare Provider Details

I. General information

NPI: 1679716054
Provider Name (Legal Business Name): ADHD & AUTISM ADVOCATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 GENESEE ST SUITE 505
UTICA NY
13502-4636
US

IV. Provider business mailing address

258 GENESEE ST SUITE 505
UTICA NY
13502-4636
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-3431
  • Fax: 866-822-2343
Mailing address:
  • Phone: 315-732-3431
  • Fax: 866-822-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP68563
License Number StateNY

VIII. Authorized Official

Name: DR. ANDY LOPEZ-WILLIAMS
Title or Position: DIRECTOR/CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 315-732-3431