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General NPI Number Information
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NPI Number | 1508195421
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Entity Type | Organization
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Legal Business Name | RAYMOND A. BODENSEICK PSY.D. PLLC
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Dates
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Enumeration Date | 12/24/2009
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Last Update Date | 12/24/2009
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Provider Practice Location Address
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Address Line | 634 PLANK RD SUITE 201
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City | CLIFTON PARK
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State | NY
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Zip | 12065-2019
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Country | US
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Telephone | 518-383-7793
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Fax | 518-383-7793
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Provider Business Mailing Address
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Address Line | 634 PLANK RD SUITE 201
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City | CLIFTON PARK
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State | NY
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Zip | 12065-2019
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Country | US
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Telephone | 518-383-7793
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Fax | 518-383-7793
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND ALAN BODENSIECK
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Credential | PSY.D.
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Telephone | 518-383-7793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 010453
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License Number State | NY
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