Provider Demographics
NPI:1235561077
Name:THE MARRIAGE AND FAMILY THERAPY GROUP PLLC
Entity Type:Organization
Organization Name:THE MARRIAGE AND FAMILY THERAPY GROUP PLLC
Other - Org Name:THE PASTORAL COUNSELING AND FAMILY THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:585-473-2671
Mailing Address - Street 1:2000 WINTON RD S
Mailing Address - Street 2:BLDG 4 SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3970
Mailing Address - Country:US
Mailing Address - Phone:585-473-2671
Mailing Address - Fax:585-473-2678
Practice Address - Street 1:2000 WINTON RD S
Practice Address - Street 2:BLDG. 4, SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3970
Practice Address - Country:US
Practice Address - Phone:585-473-2671
Practice Address - Fax:585-473-2678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-03
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty