Provider Demographics
NPI:1609952209
Name:BAXTER, WILLIAM G (MED LMHC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:BAXTER
Suffix:
Gender:M
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 KRISTIN DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1048
Mailing Address - Country:US
Mailing Address - Phone:585-594-2687
Mailing Address - Fax:
Practice Address - Street 1:12 AMITY ST
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1302
Practice Address - Country:US
Practice Address - Phone:585-352-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001795-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health