Ontario County

NPI 1003802190 - Psychologist - 103T00000X

NPI Details
NPI 1003802190
Enumeration Date 09/23/2005
Last Updated 08/22/2013
Entity Type Healthcare Provider
Active Over 12 years ago
Authorized Information
Name DIANE L DIANE
Position DIRECTOR
Phone (585) 396-4363
Fax (585) 396-4993
Practice Location
3019 COUNTY COMPLEX DR
CANANDAIGUA NY, 14424-9505, US
Phone (585) 396-4363
Fax (585) 396-4993
Business Location
3019 COUNTY COMPLEX DR
CANANDAIGUA NY, 14424-9505, US
Phone (585) 396-4363
Fax (585) 396-4993
Toxanomy
Taxonomy Code 103T00000X
License State New York
License Number 6879100A
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According to our database, Ontario County NPI is 1003802190, taxonomy code is 103T00000X and license number is 6879100A, license state is located at New York. Ontario County physically located at 3019 County Complex Dr, Canandaigua NY, 14424-9505. NPI Number 1033115704 has the healthcare provider type.

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1003802190 NPI number is provided on an as is basis without warranty of any kind. 1003802190 is maintained by the National Plan & Provider Enumeration System. The contents of Ontario County are for informational purposes only.