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General NPI Number Information
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NPI Number | 1659862290
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Entity Type | Organization
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Legal Business Name | MITCHELL J LURYE,LCSWR.LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 274 N GOODMAN ST STE 283
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City | ROCHESTER
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State | NY
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Zip | 14607-1154
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Country | US
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Telephone | 585-217-6319
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Fax |
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Provider Business Mailing Address
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Address Line | 274 N GOODMAN ST STE 283
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City | ROCHESTER
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State | NY
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Zip | 14607-1154
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Country | US
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Telephone | 585-217-6319
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MITCHELL J LURYE
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Credential | LCSWR
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Telephone | 585-217-6319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 031120
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License Number State | NY
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