Provider Demographics
NPI:1467466524
Name:DAILOR, KEVIN J (LCSW-R)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:DAILOR
Suffix:
Gender:M
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 1:2080 RIDGE RD W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2725
Mailing Address - Country:US
Mailing Address - Phone:585-720-1480
Mailing Address - Fax:585-720-0024
Practice Address - Street 1:2080 RIDGE RD W
Practice Address - Street 2:SUITE 3
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2725
Practice Address - Country:US
Practice Address - Phone:585-720-1480
Practice Address - Fax:585-720-0024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0568761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY171263FKOtherPREFERRED CARE