Healthcare Provider Details

I. General information

NPI: 1710354766
Provider Name (Legal Business Name): HANNAH CONNELLY COLBERT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-0553
  • Fax: 585-922-0496
Mailing address:
  • Phone: 585-922-0527
  • Fax: 585-922-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: