Doctor Name: | MICHAEL WALES |
NPI Number: | 1164825527 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MASTER SCHOOL PSYCH |
License Number: | $$$$$$$$$ |
Business Practice Address: | 1347 Snyder Rd Alfred Station, NY - 148039738 |
Business Phone Number: | 6073825866 |
Business Fax Number: | |
Mailing Address: | 1347 Snyder Rd, ALFRED STATION |
State: | NY |
Postal Code: | 148039738 |
Phone Number: | 6073825866 |
Fax Number: | |
NPI Enumeration Date: | 09/30/2014 |
NPI Last Update Date: | 09/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | $$$$$$$$$ |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |