Provider Demographics
NPI:1336462837
Name:HAZILLA, IRENE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:HAZILLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ELMWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3093
Mailing Address - Country:US
Mailing Address - Phone:585-271-0761
Mailing Address - Fax:585-442-3143
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3093
Practice Address - Country:US
Practice Address - Phone:585-271-0761
Practice Address - Fax:585-442-3143
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009363-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker