MEDICARE: KRISTA GASCON, LCSW, PLLC

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1265270540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTA GASCON, LCSW, PLLC

Provider Business Mailing Address
First Line	:	625 PANORAMA TRL STE 210
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2408
Country	:	US
Telephone Number	:	585-364-2545
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 PANORAMA TRL STE 210
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2408
Country	:	US
Telephone Number	:	585-364-2545
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER/OWN
Name	:	KRISTA MARIE GASCON
Credential	:	LCSW
Telephone Number	:	585-613-5768

Provider Enumeration Date	:	07/19/2024
Last Update Date	:	07/19/2024

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