Healthcare Provider Details

I. General information

NPI: 1417541004
Provider Name (Legal Business Name): KATHRYN ROSALIE BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE STE 100
ROCHESTER NY
14620-3042
US

IV. Provider business mailing address

1000 ELMWOOD AVE STE 100
ROCHESTER NY
14620-3042
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-2897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109421-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: