MEDICARE: MS. THERESA R. AMIE LMHC

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	101YM0800X	Mental Health Counselor	006616	NY

General Provider Information

NPI Number	:	1255712725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA R. AMIE LMHC

Provider Business Mailing Address
First Line	:	2480 BROWNCROFT BLVD
Second Line	:	SUITE L-120
City	:	ROCHESTER
State	:	NY
Zip	:	14625-1435
Country	:	US
Telephone Number	:	585-673-2519
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 BROWNCROFT BLVD
Second Line	:	SUITE L-120
City	:	ROCHESTER
State	:	NY
Zip	:	14625-1435
Country	:	US
Telephone Number	:	585-673-2519
Fax Number	:

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

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	09/13/2016

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