Healthcare Provider Details

I. General information

NPI: 1841439114
Provider Name (Legal Business Name): MRS. LORI ANNE CROSSETTA SALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LORI ANNE CROSSETTA

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 COLEBROOK DR
ROCHESTER NY
14617-2211
US

IV. Provider business mailing address

295 INGLEWOOD DR
ROCHESTER NY
14619-1439
US

V. Phone/Fax

Practice location:
  • Phone: 585-467-4567
  • Fax:
Mailing address:
  • Phone: 585-802-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number471476041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: