Healthcare Provider Details

I. General information

NPI: 1023566684
Provider Name (Legal Business Name): KAITLYN COON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6539 ANTHONY DR STE A
VICTOR NY
14564-1441
US

IV. Provider business mailing address

81 LAKE AVE
ROCHESTER NY
14608-1410
US

V. Phone/Fax

Practice location:
  • Phone: 585-398-8835
  • Fax: 585-398-7376
Mailing address:
  • Phone: 585-368-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number098175
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: