Healthcare Provider Details

I. General information

NPI: 1467362079
Provider Name (Legal Business Name): ELEANOR MATZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE
ROCHESTER NY
14620-3042
US

IV. Provider business mailing address

1000 ELMWOOD AVE
ROCHESTER NY
14620-3042
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-2520
  • Fax: 585-286-9220
Mailing address:
  • Phone: 585-271-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16-0743143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: