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General NPI Number Information
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NPI Number | 1699258251
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Entity Type | Individual
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Provider Name | ELLI E ASSIOBO-TIPOH LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 919 WINTON RD S
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City | ROCHESTER
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State | NY
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Zip | 14618-1633
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Country | US
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Telephone | 716-730-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 LAKE AVE
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City | ROCHESTER
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State | NY
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Zip | 14613-1208
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Country | US
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Telephone | 716-730-0111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0089221
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License Number State | NY
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