Provider Demographics
NPI:1073250601
Name:CLARK, BRYANNA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:BRYANNA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:BRYANNA
Other - Middle Name:
Other - Last Name:GATTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2040 W RIDGE RD STE 304
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2721
Mailing Address - Country:US
Mailing Address - Phone:585-431-6533
Mailing Address - Fax:
Practice Address - Street 1:2450 W RIDGE RD STE 304
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3037
Practice Address - Country:US
Practice Address - Phone:585-431-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health