MEDICARE: FINGERLAKES LCSW COUNSELING SERVICES, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1609340868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FINGERLAKES LCSW COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	33 WILLIAM ST STE 7
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-3730
Country	:	US
Telephone Number	:	315-209-8818
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 WILLIAM ST STE 7
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-3730
Country	:	US
Telephone Number	:	315-209-8818
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL WORKER
Name	:	SARA LEWIS
Credential	:	LCSW-R
Telephone Number	:	315-209-8818

Provider Enumeration Date	:	01/21/2019
Last Update Date	:	01/21/2019

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