Healthcare Provider Details

I. General information

NPI: 1255478780
Provider Name (Legal Business Name): HARRY M MERRYMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 MONROE AVE
ROCHESTER NY
14618-1423
US

IV. Provider business mailing address

47 LINDEN ST
ROCHESTER NY
14620-2309
US

V. Phone/Fax

Practice location:
  • Phone: 585-721-7234
  • Fax:
Mailing address:
  • Phone: 585-721-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number012823
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: