Individual
JEFFREY R ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
279 TROY RD, RENSSELAER, NY 12144-9499
(518) 286-1922
(518) 286-3225
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
(518) 649-4094
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
005743
NY
Other
Enumeration date
10/06/2006
Last updated
06/11/2021
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