Edward Lake, NCSP

NPI #1427319409 in Ballston Spa, New York

Provider Information

NPI Number: 1427319409
Entity Type: Individual
Name: Edward Lake, NCSP
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - School
Credential: NCSP
Enumeration Date: Jun 6, 2012
Last Updated: Jun 6, 2012

Practice Location

Address: 39 LEWIS ST
City: Ballston Spa
State: New York
ZIP Code: 12020-1925
Phone: (518) 885-9863

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - School — School	103TS0200X	Primary

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