Provider Demographics
NPI:1689210072
Name:PEAVY, VANESSA DANNIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:DANNIELLE
Last Name:PEAVY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:THE UNIVERSITY OF ROCHESTER
Mailing Address - Street 2:738 LIBRARY RD.
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14627
Mailing Address - Country:US
Mailing Address - Phone:585-820-2822
Mailing Address - Fax:
Practice Address - Street 1:THE UNIVERSITY OF ROCHESTER
Practice Address - Street 2:738 LIBRARY RD.
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14627-1462
Practice Address - Country:US
Practice Address - Phone:585-820-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0882811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical