Healthcare Provider Details

I. General information

NPI: 1023762150
Provider Name (Legal Business Name): LAUREN KROENING LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MUSTARD ST STE 240250
ROCHESTER NY
14609-6980
US

IV. Provider business mailing address

1 MUSTARD ST STE 240250
ROCHESTER NY
14609-6980
US

V. Phone/Fax

Practice location:
  • Phone: 585-256-7500
  • Fax: 585-654-1718
Mailing address:
  • Phone:
  • Fax: 585-654-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: