Organization
EVERGREEN MENTAL HEALTH & ASSESSMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER JOSEPH HINNEBUSCH PH.D. (OWNER)
(240) 274-0012
Entity
Organization
Contact information
Practice address
4758 LYNNVILLE WAY, CLAY, NY 13041-8990
(240) 274-0012
Mailing address
4758 LYNNVILLE WAY, CLAY, NY 13041-8990
(240) 274-0012
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
12/21/2022
Last updated
12/21/2022
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