MEDICARE: KRISTA MARIE GASCON LCSW-R

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	1041C0700X	Clinical Social Worker	081081	NY

General Provider Information

NPI Number	:	1316241094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA MARIE GASCON LCSW-R

Provider Business Mailing Address
First Line	:	625 PANORAMA TRL STE 210
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2408
Country	:	US
Telephone Number	:	585-642-5453
Fax Number	:	585-267-7001

Provider Business Practice Location Address
First Line	:	625 PANORAMA TRL STE 210
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2408
Country	:	US
Telephone Number	:	585-364-2545
Fax Number	:	585-364-2545

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

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	05/04/2022

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