Provider Demographics
NPI:1558985655
Name:HAZLITT, ROSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:
Last Name:HAZLITT
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 1:5510 PEACH ORCHARD PT
Mailing Address - Street 2:
Mailing Address - City:HECTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14841
Mailing Address - Country:US
Mailing Address - Phone:607-481-3070
Mailing Address - Fax:
Practice Address - Street 1:5297 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-7504
Practice Address - Country:US
Practice Address - Phone:607-481-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021564103TS0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty