Provider Demographics
NPI:1649765173
Name:SY, MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18798 OLD YONGE STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLAND LANDING
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L9N0L1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18798 OLD YONGE STREET
Practice Address - Street 2:
Practice Address - City:HOLLAND LANDING
Practice Address - State:ONTARIO
Practice Address - Zip Code:L9N0L1
Practice Address - Country:CA
Practice Address - Phone:905-727-4214
Practice Address - Fax:905-895-6296
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3107103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral