MEDICARE: MS. SUSAN LEA CHAPEL

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	004409	NY

General Provider Information

NPI Number	:	1356814289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN LEA CHAPEL

Provider Business Mailing Address
First Line	:	21 MENLO PL
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2717
Country	:	US
Telephone Number	:	585-484-0345
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 HARVARD ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2607
Country	:	US
Telephone Number	:	585-484-0345
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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