MEDICARE: DR. OLIVER BOXELL PH.D., LMHCP, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P112998	NY

General Provider Information

NPI Number	:	1013647635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVER BOXELL PH.D., LMHCP, NCC

Provider Business Mailing Address
First Line	:	1100 GOODMAN ST S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2530
Country	:	US
Telephone Number	:	585-857-9012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 GOODMAN ST S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2530
Country	:	US
Telephone Number	:	585-857-9012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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