Healthcare Provider Details

I. General information

NPI: 1346523149
Provider Name (Legal Business Name): PAMELA M. RODRIGUEZ LCSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W BROAD ST
ROCHESTER NY
14614-1103
US

IV. Provider business mailing address

275 DALE RD
ROCHESTER NY
14625-2068
US

V. Phone/Fax

Practice location:
  • Phone: 585-262-8100
  • Fax:
Mailing address:
  • Phone: 585-797-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: