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General NPI Number Information
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NPI Number | 1679114169
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Entity Type | Organization
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Legal Business Name | GENESEE VALLEY PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 10/05/2019
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 200 WHITE SPRUCE BLVD SUITE 220
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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 | 585-201-8017
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Fax | 585-495-2384
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Provider Business Mailing Address
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Address Line | 200 WHITE SPRUCE BLVD SUITE 220
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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 | 585-201-8017
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Fax | 585-495-2384
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Authorized Official
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Title or Position | DIRECTOR/OWNER OF GENESSE VALLEY PS
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Name | DR. LAUREN P WADSWORTH
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Credential | PHD
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Telephone | 585-270-1679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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