Provider Demographics
NPI:1447348859
Name:AFFILIATED PSYCHOLOGICAL CONSULTANTS PC
Entity type:Organization
Organization Name:AFFILIATED PSYCHOLOGICAL CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST SECRETARY APC
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DORTONA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:607-737-1235
Mailing Address - Street 1:410 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901
Mailing Address - Country:US
Mailing Address - Phone:607-737-1235
Mailing Address - Fax:607-735-9617
Practice Address - Street 1:410 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901
Practice Address - Country:US
Practice Address - Phone:607-737-1235
Practice Address - Fax:607-735-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54311AMedicare ID - Type Unspecified