Healthcare Provider Details

I. General information

NPI: 1235776931
Provider Name (Legal Business Name): EBONY PRESHETTE DUKES BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 SAINT PAUL ST
ROCHESTER NY
14621-3162
US

IV. Provider business mailing address

627 POST AVE
ROCHESTER NY
14619-2145
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-7220
  • Fax: 585-546-2607
Mailing address:
  • Phone: 585-503-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: