MEDICARE: MICHELE DINARDO-PRIEBE LCSW-R

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	1041C0700X	Clinical Social Worker	73 075133	NY

General Provider Information

NPI Number	:	1316101959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE DINARDO-PRIEBE LCSW-R

Provider Business Mailing Address
First Line	:	1387 FAIRPORT RD
Second Line	:	BUILDING 500, SUITE 540
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1387 FAIRPORT RD
Second Line	:	BUILDING 500, SUITE 540
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2003
Country	:	US
Telephone Number	:	585-503-8246
Fax Number	:

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

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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