Healthcare Provider Details

I. General information

NPI: 1366751323
Provider Name (Legal Business Name): DEBORAH ANN EBRAHIMI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE
ROCHESTER NY
14620-3093
US

IV. Provider business mailing address

1000 ELMWOOD AVE
ROCHESTER NY
14620-3093
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-2897
  • Fax: 585-442-3143
Mailing address:
  • Phone: 585-271-2897
  • Fax: 585-442-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number070427-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: