Provider Demographics
NPI:1265822472
Name:SYDOR-KAUFFMAN, MELISSA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:SYDOR-KAUFFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SYDOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:36 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1326
Mailing Address - Country:US
Mailing Address - Phone:585-358-0609
Mailing Address - Fax:585-625-0398
Practice Address - Street 1:300 CRITTENDEN BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-2157
Practice Address - Fax:585-276-0422
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077614-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical