Provider Demographics
NPI:1982376877
Name:HEATHER A PENROSE LCSW PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:HEATHER A PENROSE LCSW PSYCHOTHERAPY PLLC
Other - Org Name:HEATHER A PENROSE LCSW-R
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PENROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:585-576-9415
Mailing Address - Street 1:119 AVERILL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1317
Mailing Address - Country:US
Mailing Address - Phone:585-330-9416
Mailing Address - Fax:
Practice Address - Street 1:119 AVERILL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1317
Practice Address - Country:US
Practice Address - Phone:585-330-9416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty