Provider Demographics
NPI:1861434854
Name:STORMS, TERA LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERA
Middle Name:LEE
Last Name:STORMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-0306
Mailing Address - Country:US
Mailing Address - Phone:585-301-7483
Mailing Address - Fax:
Practice Address - Street 1:84 AVON RD
Practice Address - Street 2:STE B
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1057
Practice Address - Country:US
Practice Address - Phone:585-301-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638379Medicaid
NYRA6606Medicare ID - Type Unspecified
NYQ43318Medicare UPIN