Provider Demographics
NPI:1447817093
Name:NORTHEAST PSYCHOLOGICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:NORTHEAST PSYCHOLOGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOBBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:518-456-2060
Mailing Address - Street 1:435 NEW KARNER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3867
Mailing Address - Country:US
Mailing Address - Phone:518-456-2060
Mailing Address - Fax:518-456-2361
Practice Address - Street 1:435 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3867
Practice Address - Country:US
Practice Address - Phone:518-456-2060
Practice Address - Fax:518-456-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty