Provider Demographics
NPI:1518422120
Name:CASSELBURY, VICTORIA (LMSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CASSELBURY
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 1:175 HUMBOLDT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1058
Mailing Address - Country:US
Mailing Address - Phone:585-545-1153
Mailing Address - Fax:
Practice Address - Street 1:175 HUMBOLDT ST STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1058
Practice Address - Country:US
Practice Address - Phone:585-545-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091199104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker