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General NPI Number Information
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NPI Number | 1265739064
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Entity Type | Individual
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Provider Name | DAVID BRIAN FORTUNA LMHC, NCC, CASAC
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Gender | Male
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 2611 WEST HENRIETTA ROAD
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City | ROCHESTER
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State | NY
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Zip | 14623
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Country | US
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Telephone | 585-275-3161
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | ROCHESTER
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State | NY
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Zip | 14467
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004404
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License Number State | NY
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