Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 015036-1 | NY |
NPI | 1073054136 |
---|---|
Provider Name | Dr. Candace Sorensen |
First Address | Rochester, NY 14616-3741 |
Second Address | Rochester, NY 14616-3741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2017 |
Last Update Date | 09/03/2017 |