Basic Information
| Provider Information | |||||||||
| NPI: | 1649701517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 FIVE LOT LN | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144149781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857056001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 556 CLINTON AVE S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146201105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854428422 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2872 | NY | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 6238 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.