1689210072 NPI number — VANESSA DANNIELLE PEAVY LCSW

Table of content: VANESSA DANNIELLE PEAVY LCSW (NPI 1689210072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689210072 NPI number — VANESSA DANNIELLE PEAVY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEAVY
Provider First Name:
VANESSA
Provider Middle Name:
DANNIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCOTT
Provider Other First Name:
VANESSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689210072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THE UNIVERSITY OF ROCHESTER
Provider Second Line Business Mailing Address:
738 LIBRARY RD.
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-820-2822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE UNIVERSITY OF ROCHESTER
Provider Second Line Business Practice Location Address:
738 LIBRARY RD.
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14627-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-820-2822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  088281 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)