MEDICARE: LIVINGSTON COUNTY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LM	OTHER	NY	BCBS INDEM PROV NUMBER
2	014006252	OTHER	NY	BCBS PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	103061EU	OTHER	NY	PREF CARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1578656302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVINGSTON COUNTY

Provider Business Mailing Address
First Line	:	4600 MILLENNIUM DR
Second Line	:
City	:	GENESEO
State	:	NY
Zip	:	14454-1197
Country	:	US
Telephone Number	:	585-243-7250
Fax Number	:	585-243-7264

Provider Business Practice Location Address
First Line	:	4600 MILLENNIUM DR
Second Line	:
City	:	GENESEO
State	:	NY
Zip	:	14454-1197
Country	:	US
Telephone Number	:	585-243-7250
Fax Number	:	585-243-7264

Authorized Official
Title or Position	:	DEPUTY PUBLIC HEALTH DIRECTOR
Name	:	JAMES JOSEPH PERAINO
Credential	:
Telephone Number	:	585-243-7270

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/31/2023

Similar Medicare Providers

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Practice Location Address:

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14454-1197

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1982778254 — ASAD MAJID M.D.
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1407980162 — KIMBERLY WILSON BUTLER LMSW
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1639292766 — ANN D MILLER
Practice Location Address:

4600 MILLENNIUM DR
GENESEO, NY
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1386767432 — MARK S BROWN
Practice Location Address:

4600 MILLENNIUM DR
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1588825244 — CATHY A GRANITA MS.ED
Practice Location Address:

4600 MILLENNIUM DR
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14454-1197

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Directions to “LIVINGSTON COUNTY ” Practice Location

Language	Start Address	Practice Location

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