Healthcare Provider Details

I. General information

NPI: 1780653931
Provider Name (Legal Business Name): GARY SCOTT WOLK LCSW-R, CASAC, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N GOODMAN ST
ROCHESTER NY
14607-1554
US

IV. Provider business mailing address

114 HIGH ST
AVON NY
14414-1006
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-6560
  • Fax:
Mailing address:
  • Phone: 585-226-3842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5666
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR058024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: