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General NPI Number Information
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NPI Number | 1881071819
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Entity Type | Organization
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Legal Business Name | BETHESDA HOUSE OF SCHENECTADY, INC.
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 834 STATE ST
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City | SCHENECTADY
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State | NY
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Zip | 12307-1202
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Country | US
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Telephone | 518-374-7873
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Fax |
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Provider Business Mailing Address
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Address Line | 834 STATE ST
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City | SCHENECTADY
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State | NY
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Zip | 12307-1202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIMARIE A SHEPPARD
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Credential |
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Telephone | 518-374-7873
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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 | 103TC0700X
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License Number State | NY
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