Healthcare Provider Details

I. General information

NPI: 1033466388
Provider Name (Legal Business Name): JUDITH LUNDQUIST LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 TITUS AVE STE B
ROCHESTER NY
14617-3519
US

IV. Provider business mailing address

572 TITUS AVE STE B
ROCHESTER NY
14617-3519
US

V. Phone/Fax

Practice location:
  • Phone: 585-451-5126
  • Fax: 585-266-9336
Mailing address:
  • Phone: 585-451-5126
  • Fax: 585-266-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0212601
License Number StateNY

VIII. Authorized Official

Name: MS. JUDITH LUNDQUIST
Title or Position: OWNER
Credential: LCSW
Phone: 585-451-5126