MEDICARE: MS. KATHLEEN ANNE WOLFSONG L.C.S.W.-R

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	048483-1	NY

General Provider Information

NPI Number	:	1629281936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANNE WOLFSONG L.C.S.W.-R

Provider Business Mailing Address
First Line	:	522 LONG ACRE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-1114
Country	:	US
Telephone Number	:	585-224-5732
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 LONG POND RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5002
Country	:	US
Telephone Number	:	585-225-2600
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	04/11/2012

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