MEDICARE: JASMINE COLEY-GORDON LCSW

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	098093	NY

General Provider Information

NPI Number	:	1700341328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE COLEY-GORDON LCSW

Provider Business Mailing Address
First Line	:	115 PLANET ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14606-3026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 CANAL LANDING BLVD STE 8
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5108
Country	:	US
Telephone Number	:	585-502-8558
Fax Number	:

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	01/22/2026

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