MEDICARE: BHAGWAT PSYCHOLOGICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	020594	NY

General Provider Information

NPI Number	:	1346602588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHAGWAT PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	5 COMPUTER DR W STE 100-07
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1613
Country	:	US
Telephone Number	:	518-309-2185
Fax Number	:	518-245-9180

Provider Business Practice Location Address
First Line	:	5 COMPUTER DR W STE 100-07
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1613
Country	:	US
Telephone Number	:	518-309-2185
Fax Number	:	518-245-9180

Authorized Official
Title or Position	:	PROVIDER
Name	:	RANJIT BHAGWAT
Credential	:	PHD
Telephone Number	:	518-309-2185

Provider Enumeration Date	:	03/27/2016
Last Update Date	:	07/07/2023

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