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General NPI Number Information
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NPI Number | 1740791839
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Entity Type | Individual
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Provider Name | LORI A TELLER-MCDONALD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 15 HIDDEN MEADOW
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City | PENFIELD
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State | NY
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Zip | 14526
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Country | US
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Telephone | 585-233-5302
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Fax |
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Provider Business Mailing Address
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Address Line | 15 HIDDEN MDW
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City | PENFIELD
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State | NY
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Zip | 14526-1652
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Country | US
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Telephone | 585-233-5302
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 082727-1
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License Number State | NY
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