Healthcare Provider Details

I. General information

NPI: 1023169877
Provider Name (Legal Business Name): COURTNEY ANNE VALERIO-KONECNY LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
DANSVILLE NY
14437-1709
US

IV. Provider business mailing address

1745 BLOSSOM RD
ROCHESTER NY
14610-2313
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax:
Mailing address:
  • Phone: 585-355-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: