MEDICARE: MS. GEORGIA RUTH STADERMAN 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	R033707-1	NY

General Provider Information

NPI Number	:	1851623532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GEORGIA RUTH STADERMAN LCSW

Provider Business Mailing Address
First Line	:	1597 RIDGE RD W STE 301
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2513
Country	:	US
Telephone Number	:	585-281-2017
Fax Number	:	585-865-0234

Provider Business Practice Location Address
First Line	:	1597 RIDGE RD W STE 301
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2513
Country	:	US
Telephone Number	:	585-281-2017
Fax Number	:	585-865-0234

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

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/05/2010

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