Healthcare Provider Details

I. General information

NPI: 1194035410
Provider Name (Legal Business Name): MARC J BIGSBY LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 COLEBROOK DR
ROCHESTER NY
14617-2216
US

IV. Provider business mailing address

150 COLEBROOK DR
ROCHESTER NY
14617-2216
US

V. Phone/Fax

Practice location:
  • Phone: 585-336-0807
  • Fax:
Mailing address:
  • Phone: 585-336-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number065520
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: