Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 007397 | NY |
N | 103T00000X | Psychologist | 007397 | NY |
Y | 103G00000X | Clinical Psychologist | 007397 | NY |
Y | 103TC0700X | Clinical Psychologist | 007397 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 007397 | NY |
NPI | 1124134226 |
---|---|
Provider Name | Linda R Rapp-Bennett |
First Address | Fairport, NY 14450 |
Second Address | Fairport, NY 14450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100241FC | PREFERRED CARE (01) | NY |
7193383 | AETNA (01) | NY |
7700150 | MVP HEALTH CARE (01) | |
P010007397 | BC/BS- EXSELLUS (01) | NY |