Provider Demographics
NPI:1750496543
Name:LELITO, RONALD (PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:LELITO
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 1:5820 MAIN ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5776
Mailing Address - Country:US
Mailing Address - Phone:716-632-4942
Mailing Address - Fax:716-632-4899
Practice Address - Street 1:5820 MAIN ST
Practice Address - Street 2:SUITE 505
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5776
Practice Address - Country:US
Practice Address - Phone:716-632-4942
Practice Address - Fax:716-632-4899
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016184103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0849Medicare ID - Type Unspecified