Healthcare Provider Details

I. General information

NPI: 1306471784
Provider Name (Legal Business Name): MICHELLE JANINE SQUICCIARINI-BETERBIYEV LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 LAKE AVE
ROCHESTER NY
14608-1410
US

IV. Provider business mailing address

228 EAST AVE
ALBION NY
14411-1617
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6901
  • Fax: 585-368-6955
Mailing address:
  • Phone: 585-705-7917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: