Healthcare Provider Details

I. General information

NPI: 1174711485
Provider Name (Legal Business Name): ALTOONIAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 ROUTE 104
ONTARIO NY
14519-8935
US

IV. Provider business mailing address

107 DRUID HILL PARK
ROCHESTER NY
14609-3151
US

V. Phone/Fax

Practice location:
  • Phone: 315-524-3589
  • Fax: 585-467-6878
Mailing address:
  • Phone: 585-467-5930
  • Fax: 585-467-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number012371
License Number StateNY

VIII. Authorized Official

Name: DR. ANN ALTOONIAN
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 585-467-5930