Healthcare Provider Details

I. General information

NPI: 1689241887
Provider Name (Legal Business Name): EMILY DICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ALLENS CREEK RD
ROCHESTER NY
14618-3250
US

IV. Provider business mailing address

95 ALLENS CREEK RD STE 1-328 SUITE 1-328
ROCHESTER NY
14618-3250
US

V. Phone/Fax

Practice location:
  • Phone: 315-796-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: