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Individual

MARY LEE DICKERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
965 N GOODMAN ST, ROCHESTER, NY 14609-3930
(585) 288-3654
Mailing address
3063 CULVER RD, ROCHESTER, NY 14622-2635
(585) 338-7227

Taxonomy

Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
1041SO200X
NY
1041S0200X
School Social Worker
RO44519-1
NY

Other

Enumeration date
10/13/2011
Last updated
10/13/2011
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