Provider Demographics
NPI:1316021371
Name:PROUDFOOT, PHILIPPA J (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:PHILIPPA
Middle Name:J
Last Name:PROUDFOOT
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 1:399 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1001
Mailing Address - Country:US
Mailing Address - Phone:585-325-2160
Mailing Address - Fax:585-546-5954
Practice Address - Street 1:399 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1001
Practice Address - Country:US
Practice Address - Phone:585-325-2160
Practice Address - Fax:585-546-5954
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO44176-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical