Provider Demographics
NPI:1326026188
Name:NESBITT, ERIC B (PH D)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:B
Last Name:NESBITT
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 METRO PARK STE M104
Mailing Address - Street 2:ROCHESTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2632
Mailing Address - Country:US
Mailing Address - Phone:585-272-7853
Mailing Address - Fax:
Practice Address - Street 1:333 METRO PARK STE M104
Practice Address - Street 2:ROCHESTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2632
Practice Address - Country:US
Practice Address - Phone:585-272-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07373 1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00808282Medicaid
NY00808282Medicaid