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NPI Code Detail

MEDICARE: DR. CANDACE SORENSEN PH.D.

MEDICARE: DR. CANDACE SORENSEN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist015036-1NY

General Provider Information

NPI Number : 1073054136
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CANDACE SORENSEN PH.D.
Provider Business Mailing Address
First Line : 3300 DEWEY AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14616-3741
Country : US
Telephone Number : 585-865-1550
Fax Number : 585-865-5219
Provider Business Practice Location Address
First Line : 3300 DEWEY AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14616-3741
Country : US
Telephone Number : 585-865-1550
Fax Number : 585-865-5219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2017
Last Update Date : 03/09/2017

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