Healthcare Provider Details

I. General information

NPI: 1558985655
Provider Name (Legal Business Name): ROSE HAZLITT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5297 PARKSIDE DR
CANANDAIGUA NY
14424-7504
US

IV. Provider business mailing address

5510 PEACH ORCHARD PT
HECTOR NY
14841
US

V. Phone/Fax

Practice location:
  • Phone: 607-481-3070
  • Fax:
Mailing address:
  • Phone: 607-481-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021564
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number021564
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: