DR. MICHAEL LEE SERETNY PHD, HSPP
Clinical Neuropsychologist
West Lafayette, Indiana
Provider NPI: 1235139049
Provider Information:DR. MICHAEL LEE SERETNY PHD, HSPP
Gender: M
Sole Proprietor
Practice Location:
1203 TRACE 12 WEST LAFAYETTE, IN 47906 US
Tel: 765-430-4049 Fax: --
Business Mailing Address:
1203 TRACE 12 WEST LAFAYETTE, IN 47906 US
Tel: 765-430-4049 Fax: --
Entity Type: Individual
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | IN | 20040537A |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
STATE LICENSE | 20040537A | IN | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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