Provider Demographics
NPI:1346523883
Name:WEDDERBURN, LENNARD ALEXANDER (LMSW)
Entity Type:Individual
Prefix:MR
First Name:LENNARD
Middle Name:ALEXANDER
Last Name:WEDDERBURN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3621
Mailing Address - Country:US
Mailing Address - Phone:585-328-3440
Mailing Address - Fax:
Practice Address - Street 1:501 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3621
Practice Address - Country:US
Practice Address - Phone:585-328-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0610921041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool