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General NPI Number Information
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NPI Number | 1801315916
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Entity Type | Organization
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Legal Business Name | INTEGRAL PSYCHOLOGY CIRCLE, P.C.
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 6565 SPRING BROOK AVENUE SUITE 5
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City | RHINEBECK
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State | NY
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Zip | 12572
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Country | US
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Telephone | 845-516-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 6565 SPRING BROOK AVENUE SUITE 5
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City | RHINEBECK
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State | NY
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Zip | 12572
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Country | US
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Telephone | 845-516-4364
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Fax |
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Authorized Official
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Title or Position | OFFICER/PRINCIPAL
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Name | MS. SHERRY TANKERSLEY
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Credential | PHD
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Telephone | 845-516-4364
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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 | 021029
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 012483
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License Number State | NY
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