Provider Demographics
NPI:1689609414
Name:SERGENT, MARIE TERESE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:TERESE
Last Name:SERGENT
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 1:359 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2902
Mailing Address - Country:US
Mailing Address - Phone:585-244-0613
Mailing Address - Fax:585-244-0629
Practice Address - Street 1:247 PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2723
Practice Address - Country:US
Practice Address - Phone:585-244-0613
Practice Address - Fax:585-244-0629
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012169-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist