Provider Demographics
NPI:1184793614
Name:ADRAGNA, MICHELE (LCSW-R)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ADRAGNA
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 1:6000 KNAPP RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8979
Mailing Address - Country:US
Mailing Address - Phone:585-234-1194
Mailing Address - Fax:
Practice Address - Street 1:1 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1014
Practice Address - Country:US
Practice Address - Phone:585-234-1194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042029-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPO 10042029OtherBCBS
NY100418FKOtherPREFERRED CARE HMO