Healthcare Provider Details

I. General information

NPI: 1114323037
Provider Name (Legal Business Name): KRISTIN LUCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 SCOTTSVILLE RD
ROCHESTER NY
14623-2021
US

IV. Provider business mailing address

300 HYLAN DR # 145
ROCHESTER NY
14623-4216
US

V. Phone/Fax

Practice location:
  • Phone: 585-429-2700
  • Fax: 585-429-2800
Mailing address:
  • Phone: 585-350-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73 078416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: