Active NPI
Mark K Cederbaum, PSY.D.
- Clinical Psychologist
- Latham, NY
National Provider Identifier
1457409583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 016544-1
- Practice address
- 3 Lear Jet LN
Behavioral Health Specialists PLLC, Suite 105
Latham, NY 12110-2314 - Phone
- (518) 785-3614
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 016544-1 | NY | Primary |
Addresses
Primary practice location
3 Lear Jet LN
Behavioral Health Specialists PLLC, Suite 105
Latham, NY 12110-2314
Mailing address
325 County Route 76
Mechanicville, NY 12118-2741
Phone (518) 956-3465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016544-1 | NY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavioral Health Specialists, PLLC | Clinical | Past | Accepting new patients |
| Center for Disability Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Case Management Agency
- Albany, NY
- NPI 1073681557
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457409583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 COUNTY ROUTE 76",
"city": "MECHANICVILLE",
"state": "NY",
"postal_code": "121182741",
"telephone_number": "518-956-3465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 LEAR JET LN",
"address_2": "BEHAVIORAL HEALTH SPECIALISTS PLLC, SUITE 105",
"city": "LATHAM",
"state": "NY",
"postal_code": "121102314",
"telephone_number": "518-785-3614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CEDERBAUM",
"first_name": "MARK",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "016544-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Latham, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.