MEDICARE: MS. SUSAN KATHLEEN O'GARA 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	101YM0800X	Mental Health Counselor	089525	NY

General Provider Information

NPI Number	:	1548875826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN KATHLEEN O'GARA LCSW

Provider Business Mailing Address
First Line	:	354 BALLAD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-1232
Country	:	US
Telephone Number	:	585-502-0228
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 ALLENS CREEK RD STE 17
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3252
Country	:	US
Telephone Number	:	585-502-0228
Fax Number	:

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

Provider Enumeration Date	:	09/13/2020
Last Update Date	:	09/13/2020

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