Provider Demographics
NPI:1992809016
Name:BEHAVIORAL HEALTH SPECIALISTS, PLLC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MARRAZO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-785-3614
Mailing Address - Street 1:3 LEAR JET LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2509
Mailing Address - Country:US
Mailing Address - Phone:518-785-3614
Mailing Address - Fax:518-785-8786
Practice Address - Street 1:3 LEAR JET LN
Practice Address - Street 2:SUITE 105
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2509
Practice Address - Country:US
Practice Address - Phone:518-785-3614
Practice Address - Fax:518-785-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4777103TC0700X
NYPR004365-11041C0700X
NY1659022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55299AMedicare ID - Type Unspecified