Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 017077 | NY |
Y | 103T00000X | Psychologist | 017077 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1788 | CO |
N | 103G00000X | Clinical Psychologist | 017077 | NY |
N | 103TC0700X | Clinical Psychologist | 017077 | NY |
NPI | 1194781146 |
---|---|
Provider Name | Dr. Kurt Stephen Halliday |
First Address | Potsdam, NY 13676 |
Second Address | Canton, NY 13617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 03/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
95926534 | (05) | CO |