Provider Demographics
NPI:1114586393
Name:PAIGE OUIMETTE, PHD, PSYCHOLOGIST, PC
Entity Type:Organization
Organization Name:PAIGE OUIMETTE, PHD, PSYCHOLOGIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:OUIMETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-436-5825
Mailing Address - Street 1:116 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1912
Mailing Address - Country:US
Mailing Address - Phone:315-436-5825
Mailing Address - Fax:315-679-4214
Practice Address - Street 1:1101 ERIE BLVD E STE 206
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1144
Practice Address - Country:US
Practice Address - Phone:315-436-5825
Practice Address - Fax:315-679-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty