Active NPI
Andrea Fedoruk, LCSW
- Clinical Social Worker
- Rochester, NY
National Provider Identifier
1740488956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 053976
- Practice address
- 81 Lake Ave
Rochester, NY 14608-1410 - Phone
- (585) 368-6900
- NPI assigned
- Jul 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 053976 | NY | Primary |
Addresses
Primary practice location
81 Lake Ave
Rochester, NY 14608-1410
Mailing address
81 Lake Ave
Rochester, NY 14608-1410
Phone (585) 368-6900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 053976 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184025600000",
"number": "1740488956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81 LAKE AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146081410",
"telephone_number": "585-368-6900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "81 LAKE AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146081410",
"telephone_number": "585-368-6900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDORUK",
"first_name": "ANDREA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-10",
"last_updated": "2007-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "053976",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.