Healthcare Provider Details

I. General information

NPI: 1154969913
Provider Name (Legal Business Name): KATHERINE S HOPPER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KATHERINE S O'HARA

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 09/10/2026
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 CLIFFORD AVE
ROCHESTER NY
14621
US

IV. Provider business mailing address

1445 CLIFFORD AVE
ROCHESTER NY
14621
US

V. Phone/Fax

Practice location:
  • Phone: 585-325-6945
  • Fax:
Mailing address:
  • Phone: 585-325-6945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104152
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number104152-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: