Organization
DEPAUL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM WHALEN (VICE PRESIDENT, FINANCE)
(585) 426-8000
Entity
Organization
Contact information
Practice address
774 W MAIN ST, ROCHESTER, NY 14611-2331
(585) 464-8870
(585) 464-8077
Mailing address
1931 BUFFALO RD, ROCHESTER, NY 14624-1535
(585) 426-8000
(585) 426-8082
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00689721
—
NY
Enumeration date
08/22/2005
Last updated
08/22/2020
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