Provider Demographics
NPI:1922020791
Name:DANISZEWSKI, KATHLEEN (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:DANISZEWSKI
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 1:687 LEE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4257
Mailing Address - Country:US
Mailing Address - Phone:585-254-4110
Mailing Address - Fax:
Practice Address - Street 1:687 LEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4257
Practice Address - Country:US
Practice Address - Phone:585-254-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO41672-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY171570FKOtherPREFERRED CARE
NY7700451OtherMVP
NYPO10041672OtherEXCELLUS
NY7631413OtherAETNA HEALTH CARE