Provider Demographics
NPI:1174728562
Name:PAGE, TIMOTHY (MA CAS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:MA CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1647
Mailing Address - Country:US
Mailing Address - Phone:585-590-6061
Mailing Address - Fax:
Practice Address - Street 1:801 CEDAR CIR
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1647
Practice Address - Country:US
Practice Address - Phone:585-590-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool