Provider Demographics
NPI:1477213650
Name:REEVE, CORY
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:REEVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 JAY ST BLDG P
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-1164
Mailing Address - Country:US
Mailing Address - Phone:585-298-6839
Mailing Address - Fax:
Practice Address - Street 1:1099 JAY ST BLDG P
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-1164
Practice Address - Country:US
Practice Address - Phone:585-298-6839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health