Provider Demographics
NPI:1932331790
Name:SOBRASKE, JOHN (LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SOBRASKE
Suffix:
Gender:M
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N GOODMAN ST
Mailing Address - Street 2:SUITE 34
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1568
Mailing Address - Country:US
Mailing Address - Phone:585-271-1360
Mailing Address - Fax:
Practice Address - Street 1:11 N GOODMAN ST
Practice Address - Street 2:SUITE 34
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1568
Practice Address - Country:US
Practice Address - Phone:585-271-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003423-1101YM0800X, 101YP2500X
NY000639-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist