Michael J Small, PH.D.
Individual provider Active NPI Clinical Neuropsychologist · Long Lake, NY
NPI 1992914360 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992914360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Neuropsychologist 103G00000X
- License
- 013837 (NY)
- Practice address
- 49 Fawn Way
Long Lake, NY 12847-0130 - Phone
- (518) 624-3346
- Fax
- (518) 624-5557
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013837 | NY | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 013837 | NY | Yes |
Addresses
Primary practice location
49 Fawn Way
Long Lake, NY 12847-0130
Mailing address
PO Box 130
Long Lake, NY 12847-0130
Phone (518) 624-3346
Other providers in Long Lake, NY
- Long Lake Central School
- Long Lake Rescue Squad Inc
- Vickie L Plumley
- Russell E Rider
- Evangeline Helen Wells
All providers in Long Lake, NY · Clinical Neuropsychologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.