Provider Demographics
NPI:1588675052
Name:SARGENT, ERICA L (PHD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:SARGENT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MAIN ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6755
Mailing Address - Country:US
Mailing Address - Phone:716-634-1184
Mailing Address - Fax:716-634-3207
Practice Address - Street 1:5500 MAIN ST
Practice Address - Street 2:SUITE 308
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6755
Practice Address - Country:US
Practice Address - Phone:716-634-1184
Practice Address - Fax:716-634-3207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical