MEDICARE: MR. MITCHELL J. LURYE LCSW-R

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	031120	NY

General Provider Information

NPI Number	:	1619107679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MITCHELL J. LURYE LCSW-R

Provider Business Mailing Address
First Line	:	274 GOODMAN ST N
Second Line	:	SUITE B283
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1154
Country	:	US
Telephone Number	:	585-217-6319
Fax Number	:

Provider Business Practice Location Address
First Line	:	274 GOODMAN ST N
Second Line	:	SUITE B283
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1154
Country	:	US
Telephone Number	:	585-217-6319
Fax Number	:

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

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	04/09/2014

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