Healthcare Provider Details

I. General information

NPI: 1306242763
Provider Name (Legal Business Name): ROCHESTER INSTITUTE OF TECHNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOMB MEMORIAL DRIVE
ROCHESTER NY
14623
US

IV. Provider business mailing address

1 LOMB MEMORIAL DRIVE ROCHESTER INSTITUTE OF TECHNOLOGY
ROCHESTER NY
14623
US

V. Phone/Fax

Practice location:
  • Phone: 585-475-4065
  • Fax: 585-475-4067
Mailing address:
  • Phone: 585-475-4065
  • Fax: 585-475-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number020890-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number002261
License Number StateCT

VIII. Authorized Official

Name: DR. CAROLINE JOAN EASTON
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 203-915-4923