Provider Demographics
NPI:1104456193
Name:VALATIE PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:VALATIE PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:MOISAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-610-8103
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-0560
Mailing Address - Country:US
Mailing Address - Phone:518-610-8103
Mailing Address - Fax:518-732-1137
Practice Address - Street 1:1042 KINDERHOOK ST
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-9743
Practice Address - Country:US
Practice Address - Phone:518-758-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-19
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty