MEDICARE: KANZA CHATMAN LMHC-D

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		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396370904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANZA CHATMAN LMHC-D

Provider Business Mailing Address
First Line	:	PO BOX 173
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-0173
Country	:	US
Telephone Number	:	585-204-6151
Fax Number	:	585-348-2092

Provider Business Practice Location Address
First Line	:	103 CANAL LANDING BLVD STE 8
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5108
Country	:	US
Telephone Number	:	585-204-6151
Fax Number	:

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

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	05/12/2026

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