Provider Demographics
NPI:1639540537
Name:BORMANN, KRISTY (LCSW-R)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:BORMANN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7439
Mailing Address - Country:US
Mailing Address - Phone:347-688-8494
Mailing Address - Fax:347-812-0032
Practice Address - Street 1:720 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2192
Practice Address - Country:US
Practice Address - Phone:347-688-8494
Practice Address - Fax:347-812-0032
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091038104100000X
NY0866411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker