Individual
DR. MICHAEL BRUCE LISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
423 E MAIN ST, #2, ENDICOTT, NY 13760-6940
(607) 754-1101
(607) 754-1107
Mailing address
423 E MAIN ST, #3, ENDICOTT, NY 13760-6940
(607) 754-1101
(607) 754-1107
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
0810004531
VA
103TC0700X
Clinical Psychologist
Primary
021193-1
NY
103TC0700X
Clinical Psychologist
0810004531
VA
Other
Enumeration date
03/27/2012
Last updated
08/12/2015
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