Healthcare Provider Details

I. General information

NPI: 1477323186
Provider Name (Legal Business Name): GREATER ROCHESTER AREA COMMUNITY EXPERIENCE LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WINTHROP ST
ROCHESTER NY
14607-1326
US

IV. Provider business mailing address

36 WINTHROP ST
ROCHESTER NY
14607-1326
US

V. Phone/Fax

Practice location:
  • Phone: 585-502-1445
  • Fax: 585-625-0398
Mailing address:
  • Phone: 585-502-1445
  • Fax: 585-625-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: VILMA L VENDRELL
Title or Position: OWNER
Credential: LCSW-R
Phone: 585-502-1445