MEDICARE: JACLYN PASSERO 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	023287	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P010023278	OTHER	NY	BLUE CROSS BLUE SHIELD
2	102044FK	OTHER	NY	PREFERRED CARE
3	7741364	OTHER	TX	AETNA
4	1095227	OTHER	MN	CIGNA BEHAVIORAL HEALTH
5	P010023278	OTHER	NY	MONROE PLAN
6	P010023278	OTHER	NY	BLUE CHOICE

General Provider Information

NPI Number	:	1710945803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN PASSERO LCSW

Provider Business Mailing Address
First Line	:	2190 CULVER RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-2746
Country	:	US
Telephone Number	:	585-339-9150
Fax Number	:	585-339-9150

Provider Business Practice Location Address
First Line	:	2190 CULVER RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-2746
Country	:	US
Telephone Number	:	585-339-9150
Fax Number	:	585-339-9150

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	03/18/2024

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Directions to “ JACLYN PASSERO LCSW” Practice Location

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