Healthcare Provider Details

I. General information

NPI: 1043044092
Provider Name (Legal Business Name): SOUTHERN TIER PSYCHOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 STATE ROUTE 244
ALFRED STATION NY
14803
US

IV. Provider business mailing address

5268 LANDIS RD
HORNELL NY
14843-9026
US

V. Phone/Fax

Practice location:
  • Phone: 585-204-7560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL ANNE GARDNER
Title or Position: CEO/PRESIDENT
Credential: PHD
Phone: 585-204-7560