Healthcare Provider Details

I. General information

NPI: 1417488602
Provider Name (Legal Business Name): ANDREA MICHELLE WOODARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 N CLINTON AVE
ROCHESTER NY
14604-1455
US

IV. Provider business mailing address

179 SULLYS TRL
PITTSFORD NY
14534-4500
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-7220
  • Fax: 585-770-1116
Mailing address:
  • Phone: 585-276-6900
  • Fax: 585-742-4215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: