Provider Demographics
NPI:1356622062
Name:SIRROCCO, MYRIAH (PSYD)
Entity type:Individual
Prefix:
First Name:MYRIAH
Middle Name:
Last Name:SIRROCCO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-2178
Mailing Address - Country:US
Mailing Address - Phone:254-217-6270
Mailing Address - Fax:914-965-3883
Practice Address - Street 1:19 GREENRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1201
Practice Address - Country:US
Practice Address - Phone:914-949-7680
Practice Address - Fax:914-949-3525
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY NPI #
NY00355940OtherAGENCY MEDICIAD #
NYWVE061OtherAGENCY MEDICARE #