Provider Demographics
NPI:1639455058
Name:SEWRUK, MELISSA A (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:SEWRUK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-1860
Mailing Address - Country:US
Mailing Address - Phone:585-245-6335
Mailing Address - Fax:585-248-6392
Practice Address - Street 1:222 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1860
Practice Address - Country:US
Practice Address - Phone:585-245-6335
Practice Address - Fax:585-248-6392
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0790261041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool