MEDICARE: MITCHELL J LURYE,LCSWR.LLC

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	302F00000X	Exclusive Provider Organization	031120	NY

General Provider Information

NPI Number	:	1659862290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL J LURYE,LCSWR.LLC

Provider Business Mailing Address
First Line	:	274 N GOODMAN ST STE 283
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1154
Country	:	US
Telephone Number	:	585-217-6319
Fax Number	:

Provider Business Practice Location Address
First Line	:	274 N GOODMAN ST STE 283
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1154
Country	:	US
Telephone Number	:	585-217-6319
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MITCHELL J LURYE
Credential	:	LCSWR
Telephone Number	:	585-217-6319

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	05/18/2018

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