Provider Demographics
NPI:1518346873
Name:TAM, STANLEY
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:TAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 ROUTE 244
Mailing Address - Street 2:
Mailing Address - City:ALFRED STATION
Mailing Address - State:NY
Mailing Address - Zip Code:14803
Mailing Address - Country:US
Mailing Address - Phone:212-725-1057
Mailing Address - Fax:
Practice Address - Street 1:1655 ELMWOOD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3429
Practice Address - Country:US
Practice Address - Phone:212-725-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical