Healthcare Provider Details

I. General information

NPI: 1841845906
Provider Name (Legal Business Name): KRISTOFER ROUNSVILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 ROBERT HART DR
DANSVILLE NY
14437-8931
US

IV. Provider business mailing address

6302 MCNEIL RD
DANSVILLE NY
14437-9024
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax: 585-335-3577
Mailing address:
  • Phone: 585-474-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011974
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: