Individual
TODD STORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
556 CLINTON AVE S, ROCHESTER, NY 14620-1105
(585) 442-8422
(585) 442-8494
Mailing address
79 GLENRIDGE RD, GLENVILLE, NY 12302-4528
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
41414-T
NY
101YA0400X
Addiction (Substance Use Disorder) Counselor
P6377
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420800
—
NY
Enumeration date
02/10/2023
Last updated
11/04/2025
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