MEDICARE: BARRY B PLATT PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0063971	NY

General Provider Information

NPI Number	:	1093755928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY B PLATT PHD

Provider Business Mailing Address
First Line	:	58 SUMMIT DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3130
Country	:	US
Telephone Number	:	585-461-2017
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 LAKEVIEW PARK
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14613-1708
Country	:	US
Telephone Number	:	585-647-6414
Fax Number	:	585-458-3477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/20/2010

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