Basic Information
| Provider Information | |||||||||
| NPI: | 1174036149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYDAIRK | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5B HAMMOND DR | ||||||||
| Address2: | |||||||||
| City: | WILTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128311448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183644639 | ||||||||
| FaxNumber: | 5183996860 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 FRANKLIN ST STE 204 | ||||||||
| Address2: | |||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123052100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183727031 | ||||||||
| FaxNumber: | 5183727064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2017 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.