Healthcare Provider Details

I. General information

NPI: 1407003189
Provider Name (Legal Business Name): HEATHER ELSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ALEXANDER ST
ROCHESTER NY
14607-4000
US

IV. Provider business mailing address

224 ALEXANDER ST
ROCHESTER NY
14607-4000
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-8040
  • Fax: 585-922-7225
Mailing address:
  • Phone: 585-922-8040
  • Fax: 585-922-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088883
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number071193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: