Provider Demographics
NPI:1841845906
Name:ROUNSVILLE, KRISTOFER
Entity type:Individual
Prefix:
First Name:KRISTOFER
Middle Name:
Last Name:ROUNSVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 MCNEIL RD
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9024
Mailing Address - Country:US
Mailing Address - Phone:585-474-0440
Mailing Address - Fax:
Practice Address - Street 1:9221 ROBERT HART DR
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-8931
Practice Address - Country:US
Practice Address - Phone:585-335-4316
Practice Address - Fax:585-335-3577
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011974101YM0800X
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health