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General NPI Number Information
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NPI Number | 1023566684
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Entity Type | Individual
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Provider Name | KAITLYN COON LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 6539 ANTHONY DR STE A
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City | VICTOR
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State | NY
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Zip | 14564-1441
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Country | US
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Telephone | 585-398-8835
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Fax | 585-398-7376
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Provider Business Mailing Address
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Address Line | 81 LAKE AVE
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City | ROCHESTER
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State | NY
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Zip | 14608-1410
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Country | US
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Telephone | 585-368-6900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 098175
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 098175
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License Number State | NY
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