Healthcare Provider Details

I. General information

NPI: 1497472948
Provider Name (Legal Business Name): EMILY SUZANNE PELKEY LCAT-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 PITTSFORD VICTOR RD STE 150
PITTSFORD NY
14534-3834
US

IV. Provider business mailing address

9 WINDSORSHIRE DR APT C
ROCHESTER NY
14624-1211
US

V. Phone/Fax

Practice location:
  • Phone: 585-430-9877
  • Fax:
Mailing address:
  • Phone: 315-323-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberP118560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: