Individual
ODESSA D DESPOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1455 E RIDGE RD, ROCHESTER, NY 14621-2006
(585) 922-4698
(585) 922-5702
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
020147
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00355940
AGENCY MEDICAID PROVIDER ID
NY
01
—
1285628552
AGENCY NPI#
NY
01
—
WVE061
AGENCY MEDICARE ID#
NY
Enumeration date
08/18/2010
Last updated
11/10/2023
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