=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386607679
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUNE COLLINGS OGDEN LCSW, ACSW, CASAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2006
-----------------------------------------------------
Last Update Date | 06/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 72 MONTEROY RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-1212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-246-7007
-----------------------------------------------------
Fax | 585-434-5819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 72 MONTEROY RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-1212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-246-7007
-----------------------------------------------------
Fax | 585-434-5819
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R046230-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------