Healthcare Provider Details

I. General information

NPI: 1245389634
Provider Name (Legal Business Name): JOSEPH O'GORMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 SENECA ST
WEST SENECA NY
14224-3433
US

IV. Provider business mailing address

3802 SENECA ST
WEST SENECA NY
14224-3433
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-5418
  • Fax: 716-677-4240
Mailing address:
  • Phone: 716-677-5418
  • Fax: 716-677-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0121001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: