MEDICARE: JASMIN DZAFEROVIC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	33495	NY

General Provider Information

NPI Number	:	1619455003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMIN DZAFEROVIC

Provider Business Mailing Address
First Line	:	1099 JAY ST BLDG J
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14611-1153
Country	:	US
Telephone Number	:	585-328-0834
Fax Number	:	585-436-0103

Provider Business Practice Location Address
First Line	:	1099 JAY ST BLDG J
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14611-1153
Country	:	US
Telephone Number	:	585-328-0834
Fax Number	:	585-436-0103

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

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/30/2018

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