Provider Demographics
NPI:1164825527
Name:WALES, MICHAEL (MASTER SCHOOL PSYCH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WALES
Suffix:
Gender:M
Credentials:MASTER SCHOOL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:ALFRED STATION
Mailing Address - State:NY
Mailing Address - Zip Code:14803-9738
Mailing Address - Country:US
Mailing Address - Phone:607-382-5866
Mailing Address - Fax:
Practice Address - Street 1:1347 SNYDER RD
Practice Address - Street 2:
Practice Address - City:ALFRED STATION
Practice Address - State:NY
Practice Address - Zip Code:14803-9738
Practice Address - Country:US
Practice Address - Phone:607-382-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool