Individual
DR. J. TYSON MERRILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
313 ROAT ST, ITHACA, NY 14850-2739
(607) 279-1588
Mailing address
313 ROAT ST, ITHACA, NY 14850-2739
(607) 279-1588
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
017082
NY
Other
Enumeration date
05/24/2012
Last updated
08/28/2012
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