MEDICARE: MRS. LASHUNDA ECHOLS-SMITH MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1104046648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LASHUNDA ECHOLS-SMITH MSW

Provider Business Mailing Address
First Line	:	25 VIRGINIA AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14619-2322
Country	:	US
Telephone Number	:	585-235-3248
Fax Number	:	585-235-0765

Provider Business Practice Location Address
First Line	:	25 VIRGINIA AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14619-2322
Country	:	US
Telephone Number	:	585-235-3248
Fax Number	:	585-235-0765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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