Individual
EDWARD LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NCSP
Contact information
Practice address
39 LEWIS ST, BALLSTON SPA, NY 12020-1925
(518) 885-9863
Mailing address
39 LEWIS ST, BALLSTON SPA, NY 12020-1925
(518) 885-9863
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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