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General NPI Number Information
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NPI Number | 1285216341
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Entity Type | Organization
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Legal Business Name | STEPHEN R. GAYLORD L.C.S.W. PLLC
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 4 CHELMSFORD RD STE 2
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City | ROCHESTER
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State | NY
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Zip | 14618-1755
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Country | US
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Telephone | 585-435-4058
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Fax |
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Provider Business Mailing Address
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Address Line | 277 ALDINE ST
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City | ROCHESTER
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State | NY
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Zip | 14619-1234
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Country | US
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Telephone | 585-314-9713
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH CLINICIAN
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Name | MR. STEPHEN R. GAYLORD
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Credential | L.C.S.W.
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Telephone | 585-314-9713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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