Healthcare Provider Details

I. General information

NPI: 1346454741
Provider Name (Legal Business Name): LYNN CHAUVIN-BEZINQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 KREAG RD STE 103A
PITTSFORD NY
14534-3736
US

IV. Provider business mailing address

642 KREAG RD STE 103A
PITTSFORD NY
14534-3736
US

V. Phone/Fax

Practice location:
  • Phone: 585-203-1141
  • Fax:
Mailing address:
  • Phone: 585-203-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number000437
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: