Provider Demographics
NPI:1568022119
Name:WOOD, CLARISSA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:LYNN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:LYNN
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:110 ALLENS CREEK RD STE 230
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3304
Mailing Address - Country:US
Mailing Address - Phone:585-978-7937
Mailing Address - Fax:585-310-0240
Practice Address - Street 1:110 ALLENS CREEK RD STE 230
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3304
Practice Address - Country:US
Practice Address - Phone:585-978-7937
Practice Address - Fax:585-310-0240
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022254103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent