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General NPI Number Information
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NPI Number | 1891231916
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Entity Type | Organization
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Legal Business Name | ALISA K. PHELPS, PH.D., PSYCHOLOGIST, PLLC
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 697 HIGHLAND AVE
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City | ROCHESTER
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State | NY
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Zip | 14620-3119
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Country | US
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Telephone | 585-256-1963
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Fax | 585-256-9851
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Provider Business Mailing Address
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Address Line | 697 HIGHLAND AVE
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City | ROCHESTER
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State | NY
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Zip | 14620-3119
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Country | US
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Telephone | 585-256-1963
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Fax | 585-256-9851
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ALISA KAY PHELPS
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Credential | PH.D.
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Telephone | 585-256-1963
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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 | 013289
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License Number State | NY
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