Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 007918-1 | NY |
Y | 103T00000X | Psychologist | 007918-1 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 007918-1 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 007918-1 | NY |
N | 103G00000X | Clinical Psychologist | 007918-1 | NY |
N | 103TC0700X | Clinical Psychologist | 007918-1 | NY |
N | 103TR0400X | Rehabilitation Psychologist | 007918-1 | NY |
NPI | 1386893964 |
---|---|
Provider Name | Dr. Raymond A. Bepko |
First Address | Utica, NY 13501-6122 |
Second Address | Utica, NY 13501-6122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 18/09/2008 |