Healthcare Provider Details

I. General information

NPI: 1689258840
Provider Name (Legal Business Name): BRACHA WINOGRAD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 WEST ST
CANANDAIGUA NY
14424-1722
US

IV. Provider business mailing address

10 MEREDITH AVE
ROCHESTER NY
14618-1308
US

V. Phone/Fax

Practice location:
  • Phone: 585-738-6083
  • Fax:
Mailing address:
  • Phone: 585-738-6083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number111934
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017633
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: