NPIMap

Organization Active NPI

Monroe Licensed Clinical Social Work, P.C.

  • Clinical Social Worker
  • Rochester, NY
National Provider Identifier
1043909054
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MONROE LICENSED CLINICAL SOCIAL WORK, P.C.
Practice address
3019 Monroe Ave Ste 200R
Rochester, NY 14618-4600
Phone
(585) 920-2290
NPI assigned
May 4, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Victoria Henderson, LCSWNPI 1063744308
Title
Clinic Director
Phone
(585) 920-2290

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3019 Monroe Ave Ste 200R
Rochester, NY 14618-4600

Mailing address

3019 Monroe Ave Ste 200R
Rochester, NY 14618-4600
Phone (585) 902-2290

Other names 1

  • Ellie Mental Health Counseling Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240205002357 NY Part B Supplier - Clinic/Group Practice 3678916871 Receives reassigned benefits from 4 practitioners
Practice locations: Rochester, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1043909054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3019 MONROE AVE STE 200R",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146184600",
            "telephone_number": "585-902-2290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3019 MONROE AVE STE 200R",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146184600",
            "telephone_number": "585-920-2290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE LICENSED CLINICAL SOCIAL WORK, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-04",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "585-920-2290",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.