Provider Demographics
NPI:1578602439
Name:NAVRATIL, PETER K (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:K
Last Name:NAVRATIL
Suffix:
Gender:M
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 ONTARIO DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9344
Mailing Address - Country:US
Mailing Address - Phone:315-333-5291
Mailing Address - Fax:315-333-5291
Practice Address - Street 1:2300 EAST AVENUE
Practice Address - Street 2:# 3
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610
Practice Address - Country:US
Practice Address - Phone:585-355-7418
Practice Address - Fax:585-456-0236
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0250711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical