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Organization
ONTARIO COUNTY
Active
Organization
ONTARIO COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JESSICA MITCHELL PHD (DIRECTOR)
(585) 396-4363
Entity
Organization
Contact information
Practice address
3019 COUNTY COMPLEX DR, CANANDAIGUA, NY 14424-9505
(585) 396-4363
(585) 396-4993
Mailing address
3019 COUNTY COMPLEX DR, CANANDAIGUA, NY 14424-9505
(585) 396-4363
(585) 396-4993
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6879100A
NY
103TC0700X
Clinical Psychologist
6879100A
NY
104100000X
Social Worker
Primary
6879100A
NY
1041C0700X
Clinical Social Worker
6879100A
NY
2084P0800X
Psychiatry Physician
6879100A
NY
363L00000X
Nurse Practitioner
6879100A
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00357846
—
NY
01
—
014003729
MENTAL HEALTH OUTPATIENT
NY
01
—
103283EU
MENTAL HEALTH OUTPATIENT
NY
01
—
3109089
MENTAL HEALTH OUTPATIENT
NY
01
—
EM
MENTAL HEALTH OUTPATIENT
NY
Enumeration date
09/23/2005
Last updated
04/01/2021
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