MEDICARE: DR. LAVERN K COLE-RISTUCCIA PSY D PC

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	103TC0700X	Clinical Psychologist	NY012985	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010012985	OTHER	NY	BCBS
2	P010012985	OTHER	NY	BLUE CHOICE
3	P102037FC	OTHER	NY	PREFERRED CARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568570042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAVERN K COLE-RISTUCCIA PSY D PC

Provider Business Mailing Address
First Line	:	5 S PITTSFORD HILL LN
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618
Country	:	US
Telephone Number	:	585-507-2181
Fax Number	:	585-385-9315

Provider Business Practice Location Address
First Line	:	5 S PITTSFORD HILL LANE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2894
Country	:	US
Telephone Number	:	585-507-2181
Fax Number	:	585-385-9315

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

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	05/26/2022

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