Individual
DR. CAROLL ANN REVAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1 SAREDON PL, SUITE 300, ROCHESTER, NY 14606-4070
(585) 426-8460
(585) 426-8460
Mailing address
1 SAREDON PL, SUITE 300, ROCHESTER, NY 14606-4070
(585) 426-8460
(585) 426-8460
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
007402-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100242FC
PREFERRED CARE
NY
01
—
7700518
DOCTOR'S HEALTH PLAN MVP
NY
01
—
7760102
AETNA
NY
Enumeration date
06/27/2006
Last updated
07/08/2007
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