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General NPI Number Information
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NPI Number | 1336824648
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Entity Type | Organization
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Legal Business Name | PATH OF DISCOVERY COUNSELING SERVICES, LCSW, PLLC
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 335 RUGBY AVE
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City | ROCHESTER
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State | NY
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Zip | 14619-1243
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Country | US
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Telephone | 585-764-9017
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Fax |
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Provider Business Mailing Address
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Address Line | 21 GOODWAY DR
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City | ROCHESTER
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State | NY
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Zip | 14623-3029
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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 | OWNER
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Name | FATIMA BANISTER
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Credential | LCSW
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Telephone | 585-764-9017
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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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