Provider Demographics
NPI:1679766471
Name:OAK STREET PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:OAK STREET PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:607-772-9710
Mailing Address - Street 1:67 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4628
Mailing Address - Country:US
Mailing Address - Phone:607-772-9710
Mailing Address - Fax:607-772-2897
Practice Address - Street 1:67 OAK ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4628
Practice Address - Country:US
Practice Address - Phone:607-772-9710
Practice Address - Fax:607-772-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty