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General NPI Number Information
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NPI Number | 1528378692
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Entity Type | Organization
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Legal Business Name | ADIRONDACK CROSS ROADS PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 123 DIXON RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-2133
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Country | US
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Telephone | 518-798-2088
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Fax | 518-798-2088
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Provider Business Mailing Address
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Address Line | 123 DIXON RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-2133
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Country | US
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Telephone | 518-798-2088
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Fax | 518-798-2088
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Authorized Official
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Title or Position | ORIGINAL MANAGER/ OWNER
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Name | DR. PAUL GERARD SCHULZE
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Credential | PSYD
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Telephone | 518-798-2088
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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 | 010511
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License Number State | NY
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