Provider Demographics
NPI:1922375153
Name:PELOW-SULLIVAN, DARLENE MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:MARIE
Last Name:PELOW-SULLIVAN
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 1:190 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2540
Mailing Address - Country:US
Mailing Address - Phone:585-235-2820
Mailing Address - Fax:585-464-6174
Practice Address - Street 1:190 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2540
Practice Address - Country:US
Practice Address - Phone:585-235-2820
Practice Address - Fax:585-464-6174
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025138-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool