Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1207 | SC |
N | 103T00000X | Psychologist | 1207 | SC |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1207 | SC |
N | 103TA0700X | Adult Development & Aging Psychologist | 1207 | SC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1207 | SC |
Y | 103TC1900X | Counseling Psychologist | 1207 | SC |
N | 103TE1100X | Exercise & Sports Psychologist | 1207 | SC |
N | 103TF0000X | Family Psychologist | 1207 | SC |
N | 103TH0004X | Health Psychologist | 1207 | SC |
N | 103TP2701X | Group Psychotherapist | 1207 | SC |
NPI | 1063772382 |
---|---|
Provider Name | Dr. Holly Serrao |
First Address | Clifton Park, NY 12065-6911 |
Second Address | Niskayuna, NY 12309-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2012 |
Last Update Date | 05/10/2014 |