Provider Demographics
NPI:1225081003
Name:KOHL, MARTHA CATHERINE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:CATHERINE
Last Name:KOHL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2449
Mailing Address - Country:US
Mailing Address - Phone:585-461-3469
Mailing Address - Fax:585-461-4904
Practice Address - Street 1:58 MARKET ST
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1934
Practice Address - Country:US
Practice Address - Phone:585-746-3410
Practice Address - Fax:585-461-4904
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069430-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000929206002OtherHEALTH NOW (BCBS)
NY180089FKOtherPREFERRED CARE
NY000929206001OtherHEALTH NOW (BCBS)
NY7748784OtherAETNA (RCIPA)