Healthcare Provider Details

I. General information

NPI: 1144841784
Provider Name (Legal Business Name): REBEKAH JOY BALCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 07/30/2025
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 LAKE AVE
ROCHESTER NY
14608-1410
US

IV. Provider business mailing address

919 S WINTON RD SUITE 115
ROCHESTER NY
14618
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6901
  • Fax: 585-368-6996
Mailing address:
  • Phone: 585-420-8464
  • Fax: 585-368-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096456
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number096456
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: