Basic Information
| Provider Information | |||||||||
| NPI: | 1528349024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUDSON VALLEY PSYCHOLOGICAL & DEVELOPMENTAL SERVICES, P.C. | ||||||||
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| OtherOrganizationName: | HUDSON VALLEY CENTER FOR DEVELOPMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1124 ROUTE 94 | ||||||||
| Address2: | STE 201 | ||||||||
| City: | NEW WINDSOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454584557 | ||||||||
| FaxNumber: | 8454584559 | ||||||||
| Practice Location | |||||||||
| Address1: | 1124 ROUTE 94 | ||||||||
| Address2: | STE 201 | ||||||||
| City: | NEW WINDSOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454584557 | ||||||||
| FaxNumber: | 8454584559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2011 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | SHREM | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8454584557 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 014925-01 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.