Provider Demographics
NPI:1215152962
Name:CAPITAL DISTRICT BEHAVIORAL HEALTH PSYCHOLOGISTS, PLLC
Entity type:Organization
Organization Name:CAPITAL DISTRICT BEHAVIORAL HEALTH PSYCHOLOGISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-785-7283
Mailing Address - Street 1:20 CENTURY HILL DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-785-7283
Mailing Address - Fax:518-785-7293
Practice Address - Street 1:20 CENTURY HILL DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-785-7283
Practice Address - Fax:518-785-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty