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General NPI Number Information
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NPI Number | 1699109090
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Entity Type | Organization
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Legal Business Name | SKYTOP MENTAL HEALTH COUNSELING, PLLC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 52 MAIN ST SUITE 2B
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City | KINGSTON
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State | NY
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Zip | 12401-3828
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Country | US
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Telephone | 845-863-4588
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Fax |
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Provider Business Mailing Address
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Address Line | 52 MAIN ST SUITE 2B
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City | KINGSTON
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State | NY
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Zip | 12401-3828
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Country | US
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Telephone | 845-863-4588
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MR. BRANDON ROMAN
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Credential | LMHC
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Telephone | 845-863-4588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004739
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License Number State | NY
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