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General NPI Number Information
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NPI Number | 1134427834
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Entity Type | Organization
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Legal Business Name | BROCKPORT MARRIAGE & FAMILY THERAPY, P.C.
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 2 MAIN ST
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City | BROCKPORT
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State | NY
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Zip | 14420-1937
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Country | US
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Telephone | 585-395-0091
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Fax | 585-395-0092
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Provider Business Mailing Address
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Address Line | 2 MAIN ST
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City | BROCKPORT
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State | NY
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Zip | 14420-1937
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Country | US
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Telephone | 585-395-0091
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Fax | 585-395-0092
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNIFER H. KING
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Credential | LMFT
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Telephone | 585-395-0091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0007911
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License Number State | NY
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