Healthcare Provider Details

I. General information

NPI: 1669382685
Provider Name (Legal Business Name): ALLISON GALVANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WILLOW POND WAY STE 103
PENFIELD NY
14526-2687
US

IV. Provider business mailing address

57 NORTH AVE
ROCHESTER NY
14626-1001
US

V. Phone/Fax

Practice location:
  • Phone: 585-385-6030
  • Fax:
Mailing address:
  • Phone: 585-301-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P145747-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: