MEDICARE: LAUREN CHRISTINE TANTILLO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	096087	NY

General Provider Information

NPI Number	:	1033781703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CHRISTINE TANTILLO LCSW

Provider Business Mailing Address
First Line	:	2510 CHILI AVE STE 5
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3334
Country	:	US
Telephone Number	:	585-402-3207
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 CHILI AVE STE 6
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3334
Country	:	US
Telephone Number	:	585-402-3207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	02/07/2024

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