MEDICARE: MRS. CELINE K DOLEZEL LMHC

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	008534-1	NY

General Provider Information

NPI Number	:	1295189496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CELINE K DOLEZEL LMHC

Provider Business Mailing Address
First Line	:	435 NEW KARNER RD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-3867
Country	:	US
Telephone Number	:	518-456-2060
Fax Number	:	518-456-2361

Provider Business Practice Location Address
First Line	:	435 NEW KARNER RD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-3867
Country	:	US
Telephone Number	:	518-456-2060
Fax Number	:	518-456-2361

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

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	05/29/2024

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