Healthcare Provider Details

I. General information

NPI: 1295777217
Provider Name (Legal Business Name): JOHN PETER ESTABROOK MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N MAIN ST
CANANDAIGUA NY
14424-1446
US

IV. Provider business mailing address

2 PINEWOOD LN
NAPLES NY
14512-9286
US

V. Phone/Fax

Practice location:
  • Phone: 585-919-0014
  • Fax: 585-393-0014
Mailing address:
  • Phone: 585-531-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR042184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: