Provider Demographics
NPI:1467676841
Name:DEVINE, BRENDA MORROW (LMSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MORROW
Last Name:DEVINE
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 1:490 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1229
Mailing Address - Country:US
Mailing Address - Phone:585-922-2500
Mailing Address - Fax:585-922-2664
Practice Address - Street 1:180 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3636
Practice Address - Country:US
Practice Address - Phone:585-458-2110
Practice Address - Fax:585-922-2664
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker