MEDICARE: DR. GEOFFREY BONES PSY.D.

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	103T00000X	Psychologist	68021457	NY

General Provider Information

NPI Number	:	1417405788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY BONES PSY.D.

Provider Business Mailing Address
First Line	:	130 WEST AVE
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2138
Country	:	US
Telephone Number	:	585-975-9093
Fax Number	:	585-280-5279

Provider Business Practice Location Address
First Line	:	920 WINTON RD S
Second Line	:	SUITE A
City	:	ROCHESTER
State	:	NY
Zip	:	14618-1634
Country	:	US
Telephone Number	:	585-975-9093
Fax Number	:	585-280-5279

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

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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