Healthcare Provider Details

I. General information

NPI: 1144254715
Provider Name (Legal Business Name): CATHERINE ANN KLECKNER N.P.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ALEXANDER ST
ROCHESTER NY
14607-4002
US

IV. Provider business mailing address

224 ALEXANDER ST
ROCHESTER NY
14607-4002
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-7770
  • Fax: 585-922-7246
Mailing address:
  • Phone: 585-922-7770
  • Fax: 585-922-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: