Provider Demographics
NPI:1316273097
Name:KARKHECK, RUSSELL (PHD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:KARKHECK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 NORTHSIDE PLZ
Mailing Address - Street 2:L-7
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3521
Mailing Address - Country:US
Mailing Address - Phone:845-627-6114
Mailing Address - Fax:845-627-8404
Practice Address - Street 1:978 NORTHSIDE PLZ
Practice Address - Street 2:L-7
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3521
Practice Address - Country:US
Practice Address - Phone:845-627-6114
Practice Address - Fax:845-627-8404
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8213103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist