Provider Demographics
NPI:1477323186
Name:GREATER ROCHESTER AREA COMMUNITY EXPERIENCE LCSW PLLC
Entity Type:Organization
Organization Name:GREATER ROCHESTER AREA COMMUNITY EXPERIENCE LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VENDRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:585-502-1445
Mailing Address - Street 1:36 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1326
Mailing Address - Country:US
Mailing Address - Phone:585-502-1445
Mailing Address - Fax:585-625-0398
Practice Address - Street 1:36 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1326
Practice Address - Country:US
Practice Address - Phone:585-502-1445
Practice Address - Fax:585-625-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty