Provider Demographics
NPI:1306242763
Name:ROCHESTER INSTITUTE OF TECHNOLOGY
Entity type:Organization
Organization Name:ROCHESTER INSTITUTE OF TECHNOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-915-4923
Mailing Address - Street 1:1 LOMB MEMORIAL DRIVE
Mailing Address - Street 2:ROCHESTER INSTITUTE OF TECHNOLOGY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623
Mailing Address - Country:US
Mailing Address - Phone:585-475-4065
Mailing Address - Fax:585-475-4067
Practice Address - Street 1:1 LOMB MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-475-4065
Practice Address - Fax:585-475-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002261273R00000X
NY020890-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No273R00000XHospital UnitsPsychiatric Unit