Provider Demographics
NPI:1306160288
Name:RIEDMAN-DANGLER, VIRGINIA MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:MARY
Last Name:RIEDMAN-DANGLER
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 1:919 WINTON RD S STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1633
Mailing Address - Country:US
Mailing Address - Phone:585-241-0101
Mailing Address - Fax:585-241-0102
Practice Address - Street 1:919 WINTON RD S STE 105
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1633
Practice Address - Country:US
Practice Address - Phone:585-241-0101
Practice Address - Fax:585-241-0102
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-21
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO72541-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical