Healthcare Provider Details

I. General information

NPI: 1477461747
Provider Name (Legal Business Name): ADALA MUTHANA TAHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 JAY ST
ROCHESTER NY
14611-1153
US

IV. Provider business mailing address

101 EDGEBROOK LN
ROCHESTER NY
14617-4116
US

V. Phone/Fax

Practice location:
  • Phone: 585-328-0740
  • Fax:
Mailing address:
  • Phone: 585-362-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number132526-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: