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General NPI Number Information
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NPI Number | 1275751133
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Entity Type | Organization
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Legal Business Name | NORTHEAST PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 435 NEW KARNER RD HAVOVER SQUARE
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City | ALBANY
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State | NY
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Zip | 12205
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Country | US
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Telephone | 518-456-2060
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Fax | 518-456-2361
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Provider Business Mailing Address
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Address Line | 435 NEW KARNER RD HAVOVER SQUARE
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City | ALBANY
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State | NY
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Zip | 12205
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Country | US
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Telephone | 518-456-2060
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Fax | 518-456-2361
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. RONDA E NEVIN
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Credential |
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Telephone | 518-456-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0114752
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0697551
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 056814
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R038168
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0111791
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License Number State | NY
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