Provider Demographics
NPI:1912461427
Name:WOLBERT, EMILY ROSE (MS, LCAT, MT-BC,)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ROSE
Last Name:WOLBERT
Suffix:
Gender:F
Credentials:MS, LCAT, MT-BC,
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:SILCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCAT, MT-BC,
Mailing Address - Street 1:8028 W HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:NY
Mailing Address - Zip Code:14543-9413
Mailing Address - Country:US
Mailing Address - Phone:585-340-7060
Mailing Address - Fax:
Practice Address - Street 1:2510 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3334
Practice Address - Country:US
Practice Address - Phone:585-340-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002451101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health