Healthcare Provider Details

I. General information

NPI: 1588675052
Provider Name (Legal Business Name): ERICA L SARGENT PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MAIN ST SUITE 308
WILLIAMSVILLE NY
14221-6755
US

IV. Provider business mailing address

5500 MAIN ST SUITE 308
WILLIAMSVILLE NY
14221-6755
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-1184
  • Fax: 716-634-3207
Mailing address:
  • Phone: 716-634-1184
  • Fax: 716-634-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number16833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: