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General NPI Number Information
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NPI Number | 1225735160
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Entity Type | Individual
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Provider Name | TODD STORK
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Gender | Male
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 556 CLINTON AVE S
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City | ROCHESTER
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State | NY
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Zip | 14620-1105
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Country | US
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Telephone | 585-442-8422
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Fax | 585-442-8494
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Provider Business Mailing Address
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Address Line | 79 GLENRIDGE RD
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City | GLENVILLE
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State | NY
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Zip | 12302-4528
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Country | US
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Telephone |
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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 | 41414-T
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | P6377
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License Number State | NY
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