Healthcare Provider Details

I. General information

NPI: 1295512846
Provider Name (Legal Business Name): CATHERINE REPERTORIO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 ROUND TRAIL RD
WEST SENECA NY
14218-3724
US

IV. Provider business mailing address

96 ROUND TRAIL RD
WEST SENECA NY
14218-3724
US

V. Phone/Fax

Practice location:
  • Phone: 716-713-9573
  • Fax:
Mailing address:
  • Phone: 716-713-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: