Provider Demographics
NPI:1457499048
Name:SERUYA, BARBARA BETTY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:BETTY
Last Name:SERUYA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:SERUYA
Other - Last Name:WYNTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 5TH AVE
Mailing Address - Street 2:SUITE 802
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7708
Mailing Address - Country:US
Mailing Address - Phone:917-453-9597
Mailing Address - Fax:866-408-9457
Practice Address - Street 1:220 5TH AVE
Practice Address - Street 2:SUITE 802
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7708
Practice Address - Country:US
Practice Address - Phone:917-453-9597
Practice Address - Fax:866-408-9457
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005772-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP69967Medicare UPIN
NYVL8201Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER