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General NPI Number Information
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NPI Number | 1245463355
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Entity Type | Individual
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Provider Name | MARTI CLEMENT FAUSOLD-MOWERS ED.D., MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 15 FISHERS RD STE 214
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City | PITTSFORD
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State | NY
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Zip | 14534-9510
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Country | US
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Telephone | 585-330-0472
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Fax |
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Provider Business Mailing Address
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Address Line | 7734 LOWER FISHERS RD
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City | VICTOR
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State | NY
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Zip | 14564-8902
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Country | US
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Telephone | 585-330-0472
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R038411-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000467-1
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License Number State | NY
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