Provider Demographics
NPI:1639293061
Name:SERACINI, ANGELA MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIA
Last Name:SERACINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:SERCAINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 W 107TH ST
Mailing Address - Street 2:2-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2700
Mailing Address - Country:US
Mailing Address - Phone:212-662-3195
Mailing Address - Fax:212-305-6614
Practice Address - Street 1:312 W 107TH ST
Practice Address - Street 2:2-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2700
Practice Address - Country:US
Practice Address - Phone:212-662-3195
Practice Address - Fax:212-305-6614
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV23321Medicare ID - Type UnspecifiedPROVIDER NUMBER