Healthcare Provider Details

I. General information

NPI: 1104737477
Provider Name (Legal Business Name): WESLEY GERACE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 MONROE AVE STE 200R
ROCHESTER NY
14618-4600
US

IV. Provider business mailing address

3019 MONROE AVE STE 200R
ROCHESTER NY
14618-4600
US

V. Phone/Fax

Practice location:
  • Phone: 585-572-7017
  • Fax:
Mailing address:
  • Phone: 585-572-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: