Healthcare Provider Details

I. General information

NPI: 1518886191
Provider Name (Legal Business Name): ALISA P HATHAWAY ED.D., LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 EDINBURGH ST
ROCHESTER NY
14608-2415
US

IV. Provider business mailing address

187 EDINBURGH ST
ROCHESTER NY
14608-2415
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2991
  • Fax: 585-454-2972
Mailing address:
  • Phone: 585-330-0975
  • Fax: 585-454-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number057431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: