Provider Demographics
NPI:1730610510
Name:NURSE PRACTITIONER IN PSYCHIATRY
Entity type:Organization
Organization Name:NURSE PRACTITIONER IN PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:315-723-6031
Mailing Address - Street 1:#3 MILL 587 MAIN ST
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-1431
Mailing Address - Country:US
Mailing Address - Phone:315-723-6031
Mailing Address - Fax:315-507-5823
Practice Address - Street 1:587 MAIN ST
Practice Address - Street 2:SUITE 110A
Practice Address - City:NEW YORK MILLS
Practice Address - State:NY
Practice Address - Zip Code:13417-1431
Practice Address - Country:US
Practice Address - Phone:315-723-6031
Practice Address - Fax:315-507-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401417261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)