=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902369655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAKER MENTAL HEALTH COUNSELING, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 N PEARL ST
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12207-2309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-706-3861
-----------------------------------------------------
Fax | 518-452-4233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 N PEARL ST
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12207-2309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-706-3861
-----------------------------------------------------
Fax | 518-452-4233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RICHARD CALIENDO
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 845-706-3861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------