Healthcare Provider Details

I. General information

NPI: 1205988649
Provider Name (Legal Business Name): ANATOLE M. KOCHENKO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
DANSVILLE NY
14437-1709
US

IV. Provider business mailing address

1033 WHITLOCK RD
ROCHESTER NY
14609-1843
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax:
Mailing address:
  • Phone: 585-467-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: