Healthcare Provider Details

I. General information

NPI: 1932224789
Provider Name (Legal Business Name): CAROL S DAGOSTINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MCAULEY DR SUITE 3000
ROCHESTER NY
14610-2342
US

IV. Provider business mailing address

100 MCAULEY DR SUITE 3000
ROCHESTER NY
14610-2342
US

V. Phone/Fax

Practice location:
  • Phone: 585-478-4960
  • Fax: 585-224-3046
Mailing address:
  • Phone: 585-478-4960
  • Fax: 585-224-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071145-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: