Individual
DR. JAMES W MIKESELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
7000 E GENESEE ST BLDG C, FAYETTEVILLE, NY 13066
(315) 449-0117
(315) 449-9623
Mailing address
4465 E GENESEE ST # 303, DE WITT, NY 13214-2229
(315) 449-0117
(315) 449-9623
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TC0700X
Clinical Psychologist
Primary
010649
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018238858
—
NY
Enumeration date
09/28/2006
Last updated
06/11/2019
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