Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 007889 | NY |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 007889 | NY |
NPI | 1376734707 |
---|---|
Provider Name | Dr. Thomas Richard Zastowny |
First Address | Rochester, NY 14620-2926 |
Second Address | Rochester, NY 14620-2926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 09/08/2007 |