Provider Demographics
NPI:1548366776
Name:MCNELIS, JOANNA L (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:L
Last Name:MCNELIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:L
Other - Last Name:MARCELLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:465 WESTFALL ROAD
Mailing Address - Street 2:DEPARTMENT OF VETERAN AFFAIRS, ROCHESTER OUTPATIENT CLI
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-463-2600
Mailing Address - Fax:585-463-2669
Practice Address - Street 1:465 WESTFALL ROAD
Practice Address - Street 2:DEPARTMENT OF VETERAN AFFAIRS, ROCHESTER OUTPATIENT CLI
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-463-2600
Practice Address - Fax:585-463-2669
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0714621041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical