Provider Demographics
NPI:1679715387
Name:SORCE, CORY C (LCSW-R)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:C
Last Name:SORCE
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 1:1 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3755
Mailing Address - Country:US
Mailing Address - Phone:585-233-6060
Mailing Address - Fax:585-383-8609
Practice Address - Street 1:1 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3755
Practice Address - Country:US
Practice Address - Phone:585-233-6060
Practice Address - Fax:585-383-8609
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072796-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical