Provider Demographics
NPI:1184901399
Name:PIETRAGROME, MICHELE (LMSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:PIETRAGROME
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 1:309 DOWNSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-3814
Mailing Address - Country:US
Mailing Address - Phone:585-436-2560
Mailing Address - Fax:585-464-6100
Practice Address - Street 1:309 DOWNSVIEW DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-3814
Practice Address - Country:US
Practice Address - Phone:585-436-2560
Practice Address - Fax:585-464-6100
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
NY043-071-1104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker