Provider Demographics
NPI:1922439637
Name:PSYCHOTHERAPY PRACTICE AT LONG POND AND ENGLISH
Entity Type:Organization
Organization Name:PSYCHOTHERAPY PRACTICE AT LONG POND AND ENGLISH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-225-2525
Mailing Address - Street 1:1800 ENGLISH RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-1600
Mailing Address - Country:US
Mailing Address - Phone:585-413-0214
Mailing Address - Fax:585-473-5894
Practice Address - Street 1:1800 ENGLISH RD STE 5
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1600
Practice Address - Country:US
Practice Address - Phone:585-413-0214
Practice Address - Fax:585-473-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty