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General NPI Number Information
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NPI Number | 1689084709
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Entity Type | Organization
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Legal Business Name | RANDOM THOUGHTS PSYCHOLOGICAL THERAPY P.C.
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 1511 ROUTE 22 SUITE 128
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City | BREWSTER
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State | NY
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Zip | 10509-4020
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Country | US
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Telephone | 203-313-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 ROUTE 22 SUITE 128
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City | BREWSTER
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State | NY
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Zip | 10509-4020
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Country | US
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Telephone | 203-313-0032
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/CEO
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Name | DR. KRISTINE DANBACK
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Credential | PHD
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Telephone | 203-313-0032
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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 | 0190551
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License Number State | NY
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