MEDICARE: DR. CLARISSA LYNN WOOD PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	022254	NY
2	103TC0700X	Clinical Psychologist	022254	NY

General Provider Information

NPI Number	:	1568022119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARISSA LYNN WOOD PHD

Provider Business Mailing Address
First Line	:	36 HOLLYWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-1810
Country	:	US
Telephone Number	:	585-340-7024
Fax Number	:	585-310-0240

Provider Business Practice Location Address
First Line	:	36 HOLLYWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-1810
Country	:	US
Telephone Number	:	585-340-7024
Fax Number	:	585-310-0240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	05/29/2024

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