Doctor Name: | TIMOTHY PAGE |
NPI Number: | 1174728562 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA CAS |
License Number: | |
Business Practice Address: | 801 Cedar Cir Spencerport, NY - 145591647 |
Business Phone Number: | 5855906061 |
Business Fax Number: | |
Mailing Address: | 801 Cedar Cir, SPENCERPORT |
State: | NY |
Postal Code: | 145591647 |
Phone Number: | 5855906061 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |