Provider Demographics
NPI:1144304502
Name:ROCHESTER PSYCHOLOGICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:ROCHESTER PSYCHOLOGICAL ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUMBLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-223-5920
Mailing Address - Street 1:620 CROSSKEYS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450
Mailing Address - Country:US
Mailing Address - Phone:585-223-5920
Mailing Address - Fax:585-223-5727
Practice Address - Street 1:620 CROSSKEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-223-5920
Practice Address - Fax:585-223-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG0189452590OtherBLUE CROSS BLUE SHIELD
NYBA0023Medicare ID - Type Unspecified