Healthcare Provider Details

I. General information

NPI: 1770314015
Provider Name (Legal Business Name): KARLEE ANNE COUSINS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CANAL LANDING BLVD
ROCHESTER NY
14626-5108
US

IV. Provider business mailing address

95 ALLENS CREEK RD STE 219
ROCHESTER NY
14618-3247
US

V. Phone/Fax

Practice location:
  • Phone: 585-257-2864
  • Fax:
Mailing address:
  • Phone: 585-270-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: