Doctor Name: | DR. TAMARA JANE MICHAELIDIS |
NPI Number: | 1174783963 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 68017658 |
Business Practice Address: | 552 Linden Ave East Aurora, NY - 140522915 |
Business Phone Number: | 7166528100 |
Business Fax Number: | 7166556077 |
Mailing Address: | 552 Linden Ave, EAST AURORA |
State: | NY |
Postal Code: | 140522915 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/15/2008 |
NPI Last Update Date: | 06/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 68017658 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |