Provider Demographics
NPI:1912036625
Name:GOODRICH, KATHY A (MSW LCSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:A
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:MSW LCSW ACSW
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:VANDENBERGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSWR ACSW
Mailing Address - Street 1:1598 PENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2252
Mailing Address - Country:US
Mailing Address - Phone:585-385-6030
Mailing Address - Fax:585-385-6168
Practice Address - Street 1:1598 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2252
Practice Address - Country:US
Practice Address - Phone:585-385-6030
Practice Address - Fax:585-385-6168
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0292361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical