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Organization
JR NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Active
Organization
JR NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH EDICK PHD (HEALTHCARE ADMINISTRATOR)
(518) 788-7983
Entity
Organization
Contact information
Practice address
430 FRANKLIN ST STE 2304, SCHENECTADY, NY 12305-2018
(518) 788-7983
(866) 616-2109
Mailing address
99 HYDE BLVD, BALLSTON SPA, NY 12020-1607
(518) 368-1691
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/05/2025
Last updated
03/05/2025
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