Organization
PLATTSBURGH STATE TBI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANNE P. RYAN PH.D. (EXECUTIVE DIRECTOR)
(518) 564-3387
Entity
Organization
Contact information
Practice address
101 BROAD ST, PSYCHOLOGY DEPT, PLATTSBURGH, NY 12901-2637
(518) 564-3137
(518) 564-3397
Mailing address
101 BROAD ST, PSYCHOLOGY DEPT, PLATTSBURGH, NY 12901-2637
(518) 564-3137
(518) 564-3397
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01783797
—
NY
Enumeration date
12/11/2006
Last updated
08/22/2020
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