Provider Demographics
NPI:1043909054
Name:MONROE LICENSED CLINICAL SOCIAL WORK, P.C.
Entity Type:Organization
Organization Name:MONROE LICENSED CLINICAL SOCIAL WORK, P.C.
Other - Org Name:ELLIE MENTAL HEALTH COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-920-2290
Mailing Address - Street 1:3019 MONROE AVE STE 200R
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4600
Mailing Address - Country:US
Mailing Address - Phone:585-902-2290
Mailing Address - Fax:
Practice Address - Street 1:3019 MONROE AVE STE 200R
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4600
Practice Address - Country:US
Practice Address - Phone:585-920-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty