MEDICARE: MRS. EMILY ROSE WOLBERT MS, LCAT, MT-BC,

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	002451	NY

General Provider Information

NPI Number	:	1912461427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY ROSE WOLBERT MS, LCAT, MT-BC,

Provider Business Mailing Address
First Line	:	8028 W HENRIETTA RD
Second Line	:
City	:	RUSH
State	:	NY
Zip	:	14543-9413
Country	:	US
Telephone Number	:	585-340-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 CHILI AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3334
Country	:	US
Telephone Number	:	585-340-7060
Fax Number	:

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

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	10/14/2024

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