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General NPI Number Information
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NPI Number | 1043909054
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Entity Type | Organization
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Legal Business Name | MONROE LICENSED CLINICAL SOCIAL WORK, P.C.
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 3019 MONROE AVE STE 200R
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City | ROCHESTER
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State | NY
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Zip | 14618-4600
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Country | US
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Telephone | 585-920-2290
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 MONROE AVE STE 200R
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City | ROCHESTER
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State | NY
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Zip | 14618-4600
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Country | US
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Telephone | 585-902-2290
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MRS. VICTORIA HENDERSON
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Credential | LCSW
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Telephone | 585-920-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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