MEDICARE: DR. SUSAN VINOCOUR JD, PHD

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	103T00000X	Psychologist		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104221 FC	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1427002872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN VINOCOUR JD, PHD

Provider Business Mailing Address
First Line	:	1597 RIDGE RD W
Second Line	:	SUITE 301
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2513
Country	:	US
Telephone Number	:	585-746-4606
Fax Number	:	585-506-9592

Provider Business Practice Location Address
First Line	:	1597 RIDGE RD W
Second Line	:	SUITE 301
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2513
Country	:	US
Telephone Number	:	585-746-4606
Fax Number	:	585-506-9592

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/08/2007

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