Provider Demographics
NPI:1669482006
Name:SERAPIGLIA, JAMES M (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:SERAPIGLIA
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5702
Mailing Address - Country:US
Mailing Address - Phone:716-631-2969
Mailing Address - Fax:716-634-6236
Practice Address - Street 1:5780 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5702
Practice Address - Country:US
Practice Address - Phone:716-631-2969
Practice Address - Fax:716-634-6236
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004299103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY054011Medicare ID - Type UnspecifiedMEDICARE PROVIDER