Provider Demographics
NPI:1245878966
Name:BLUMETTI, ANTHONY EDWARD (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:BLUMETTI
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 1:5100 W. TAFT ROAD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-452-5410
Mailing Address - Fax:315-452-5413
Practice Address - Street 1:5100 W. TAFT ROAD
Practice Address - Street 2:SUITE 3B
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-452-5410
Practice Address - Fax:315-452-5413
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical