Healthcare Provider Details

I. General information

NPI: 1376734707
Provider Name (Legal Business Name): THOMAS RICHARD ZASTOWNY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 SOUTH AVE
ROCHESTER NY
14620-2926
US

IV. Provider business mailing address

1513 SOUTH AVE
ROCHESTER NY
14620-2926
US

V. Phone/Fax

Practice location:
  • Phone: 585-787-1560
  • Fax: 585-787-1560
Mailing address:
  • Phone: 585-787-1560
  • Fax: 585-787-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number007889
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number007889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: