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General NPI Number Information
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NPI Number | 1356663223
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Entity Type | Organization
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Legal Business Name | MICHELLE KWINTNER
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 120 E BUFFALO ST STE. 7
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City | ITHACA
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State | NY
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Zip | 14850-4266
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Country | US
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Telephone | 607-592-4134
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Fax |
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Provider Business Mailing Address
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Address Line | 120 E BUFFALO ST STE. 7
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City | ITHACA
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State | NY
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Zip | 14850-4266
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Country | US
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Telephone | 607-592-4134
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. MICHELLE KWINTNER
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Credential | LCSW-R
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Telephone | 607-592-4134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076591
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License Number State | NY
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