Provider Demographics
NPI:1104096056
Name:COLE, KATHY YVETTE (LMSW, CCM)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:YVETTE
Last Name:COLE
Suffix:
Gender:F
Credentials:LMSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7023
Mailing Address - Country:US
Mailing Address - Phone:585-654-7763
Mailing Address - Fax:
Practice Address - Street 1:38 QUINCY ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7023
Practice Address - Country:US
Practice Address - Phone:585-654-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066281-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical