Provider Demographics
NPI:1780053231
Name:DENEEN, TODD (PSYD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:DENEEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 PKWY 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:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015032101103T00000X
NY022010-01103TC0700X, 202C00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS22010-3IOtherWORKER'S COMPENSATION BOARD IME AUTHORIZATION NUMBER