Provider Demographics
NPI:1790259208
Name:MONGILLO, ALICIA LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LOUISE
Last Name:MONGILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 MERCHANTS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-5442
Mailing Address - Country:US
Mailing Address - Phone:585-245-4783
Mailing Address - Fax:
Practice Address - Street 1:749 MERCHANTS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-5442
Practice Address - Country:US
Practice Address - Phone:585-245-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0988731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical