Individual
BANA HAGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
65 GENESEE ST, ROCHESTER, NY 14611
(585) 368-3950
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-5462
(585) 922-1011
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
Primary
100687
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202962641
EXCELLUS
—
Enumeration date
05/23/2019
Last updated
04/30/2026
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