Healthcare Provider Details

I. General information

NPI: 1992202683
Provider Name (Legal Business Name): VICKIE MCVAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 N CLINTON AVE
ROCHESTER NY
14604-1407
US

IV. Provider business mailing address

79 N CLINTON AVE
ROCHESTER NY
14604-1407
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-1271
  • Fax:
Mailing address:
  • Phone: 585-546-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: