Provider Demographics
NPI:1851922751
Name:DR. TODD DENEEN - PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:DR. TODD DENEEN - PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:DENEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:585-749-8372
Mailing Address - Street 1:28 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9207
Mailing Address - Country:US
Mailing Address - Phone:585-749-8372
Mailing Address - Fax:
Practice Address - Street 1:20 OFFICE PARK WAY STE 125
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1781
Practice Address - Country:US
Practice Address - Phone:585-749-8372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS22010-3IOtherWORKER'S COMPENSATION BOARD IME AUTHORIZATION NUMBER