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General NPI Number Information
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NPI Number | 1184423030
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Entity Type | Organization
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Legal Business Name | PRUITT PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 200 DELAWARE AVE
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City | DELMAR
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State | NY
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Zip | 12054-1227
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Country | US
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Telephone | 518-417-1905
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Fax |
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Provider Business Mailing Address
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Address Line | 200 DELAWARE AVE
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City | DELMAR
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State | NY
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Zip | 12054-1227
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Country | US
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Telephone | 518-417-1905
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST AND OWNER
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Name | DR. NATHAN TODD PRUITT
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Credential | PHD
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Telephone | 518-417-1905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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