Individual
MR. MATHEW DAVID KILGORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
33 SUGARMILLS CIR, FAIRPORT, NY 14450-8761
(585) 694-0075
Mailing address
33 SUGARMILLS CIR, FAIRPORT, NY 14450-8761
(585) 694-0075
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
R-0441631
NY
1041S0200X
School Social Worker
Primary
R-0441631
NY
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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