Provider Demographics
NPI:1942172390
Name:DEWBERRY, CHRISTAL CHANTELL
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:CHANTELL
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SUSAN LN APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4904
Mailing Address - Country:US
Mailing Address - Phone:585-491-6646
Mailing Address - Fax:
Practice Address - Street 1:1400 PORTLAND AVE STE 54
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3014
Practice Address - Country:US
Practice Address - Phone:585-491-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker