MEDICARE: DR. EMILY LAWLER GILBERTSON PSY.D.

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	016220	NY

General Provider Information

NPI Number	:	1588695878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY LAWLER GILBERTSON PSY.D.

Provider Business Mailing Address
First Line	:	747 PRE EMPTION RD
Second Line	:
City	:	GENEVA
State	:	NY
Zip	:	14456-1335
Country	:	US
Telephone Number	:	315-789-4817
Fax Number	:	315-789-4817

Provider Business Practice Location Address
First Line	:	747 PRE EMPTION RD
Second Line	:
City	:	GENEVA
State	:	NY
Zip	:	14456-1335
Country	:	US
Telephone Number	:	315-789-4817
Fax Number	:	315-789-4817

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

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

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