Provider Demographics
NPI:1720362734
Name:PRUSAK, PATRICIA B (LMSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:PRUSAK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4807
Mailing Address - Country:US
Mailing Address - Phone:585-225-8455
Mailing Address - Fax:
Practice Address - Street 1:555 N PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1628
Practice Address - Country:US
Practice Address - Phone:585-325-2255
Practice Address - Fax:585-935-7405
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059333-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool