Provider Demographics
NPI:1962597567
Name:MICHELINI, RONALD LEWIS (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEWIS
Last Name:MICHELINI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WINSTON RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216
Mailing Address - Country:US
Mailing Address - Phone:716-832-5473
Mailing Address - Fax:
Practice Address - Street 1:960 WEST MAPLE COURT
Practice Address - Street 2:SUBURBAN ADULT SERVICES, INC
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059
Practice Address - Country:US
Practice Address - Phone:716-805-1555
Practice Address - Fax:716-805-1444
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8012103T00000X
NY008012-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000512621001OtherBLUE CROSS/BLUE SHIELD
NY620003604OtherMEDICARE RAILROAD
NY620003604OtherMEDICARE RAILROAD