Provider Demographics
NPI:1245463355
Name:FAUSOLD-MOWERS, MARTI CLEMENT (EDD, MSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:MARTI
Middle Name:CLEMENT
Last Name:FAUSOLD-MOWERS
Suffix:
Gender:F
Credentials:EDD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7734 LOWER FISHERS RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8902
Mailing Address - Country:US
Mailing Address - Phone:585-330-0472
Mailing Address - Fax:
Practice Address - Street 1:15 FISHERS RD STE 214
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-9510
Practice Address - Country:US
Practice Address - Phone:585-330-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038411-1101YM0800X
NY000467-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health