Basic Information
| Provider Information | |||||||||
| NPI: | 1639518756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITRE-CHESTNUT | ||||||||
| FirstName: | CLARA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 HUMBOLDT ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146101059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854103370 | ||||||||
| FaxNumber: | 5859787217 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 HUMBOLDT ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146101059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854103370 | ||||||||
| FaxNumber: | 5859787217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2013 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 001323 | NY | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.