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General NPI Number Information
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NPI Number | 1629097274
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Entity Type | Organization
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Legal Business Name | VA MEDICAL CENTER BATH NY
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 76 VETERANS AVE BEHAVIORAL HEALTH ROOM 511D
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City | BATH
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State | NY
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Zip | 14810-0810
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Country | US
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Telephone | 607-664-4305
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Fax |
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Provider Business Mailing Address
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Address Line | 104 TEXAS LN
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City | ITHACA
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State | NY
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Zip | 14850-1755
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Country | US
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Telephone | 607-319-0929
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MARK W LAWSON
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Credential | PH.D.
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Telephone | 607-664-4305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 94-27P
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 94-27P
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 94-27P
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 94-27P
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 94-27P
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License Number State | AR
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Taxonomy #6
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 94-27P
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License Number State | AR
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