Provider Demographics
NPI:1669419438
Name:LYMAN, ROGER CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHARLES
Last Name:LYMAN
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 1:400 FORT HILL AVE
Mailing Address - Street 2:532/300/B2
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1188
Mailing Address - Country:US
Mailing Address - Phone:585-393-7223
Mailing Address - Fax:585-393-8380
Practice Address - Street 1:400 FORT HILL AVE
Practice Address - Street 2:532/300/B2
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1159
Practice Address - Country:US
Practice Address - Phone:585-393-7223
Practice Address - Fax:585-393-8380
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004067-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical