MEDICARE: MRS. LYNN A. WASIELEWSKI LMSW

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	104100000X	Social Worker	052867-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	052867-1	OTHER	NY	LMSW

General Provider Information

NPI Number	:	1215019286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN A. WASIELEWSKI LMSW

Provider Business Mailing Address
First Line	:	PO BOX 458
Second Line	:	2107 SPRUCE STREET, NORTH COLLINS
City	:	NORTH COLLINS
State	:	NY
Zip	:	14111
Country	:	US
Telephone Number	:	716-337-3706
Fax Number	:	716-337-2723

Provider Business Practice Location Address
First Line	:	2107 SPRUCE STREET NORTH COLLINS
Second Line	:
City	:	NORTH COLLINS
State	:	NY
Zip	:	14111
Country	:	US
Telephone Number	:	716-337-3706
Fax Number	:	716-337-2723

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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