Provider Demographics
NPI:1770314015
Name:COUSINS, KARLEE ANNE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:KARLEE
Middle Name:ANNE
Last Name:COUSINS
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 1:100 REDON CIR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3710
Mailing Address - Country:US
Mailing Address - Phone:585-278-7408
Mailing Address - Fax:
Practice Address - Street 1:103 CANAL LANDING BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5108
Practice Address - Country:US
Practice Address - Phone:585-257-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124468104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker