Provider Demographics
NPI:1932750247
Name:POLES-FALK, BOBBIE LYNN
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:LYNN
Last Name:POLES-FALK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WOODSMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2746
Mailing Address - Country:US
Mailing Address - Phone:585-629-8770
Mailing Address - Fax:
Practice Address - Street 1:1 MUSTARD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-6980
Practice Address - Country:US
Practice Address - Phone:585-654-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children