Healthcare Provider Details

I. General information

NPI: 1518241231
Provider Name (Legal Business Name): VICTORIA GRACE GASHLIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 GRANGER ST
CANANDAIGUA NY
14424-1149
US

IV. Provider business mailing address

215 GRANGER ST
CANANDAIGUA NY
14424-1149
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-3865
  • Fax: 585-396-3776
Mailing address:
  • Phone: 585-396-3865
  • Fax: 585-396-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078936
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: