MEDICARE: MS. LENA KIELISZAK LMHC

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	101YM0800X	Mental Health Counselor	004142-1	NY

General Provider Information

NPI Number	:	1720367261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LENA KIELISZAK LMHC

Provider Business Mailing Address
First Line	:	1597 W RIDGE RD STE 301
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2513
Country	:	US
Telephone Number	:	585-330-2219
Fax Number	:

Provider Business Practice Location Address
First Line	:	1597 W RIDGE RD STE 301
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2513
Country	:	US
Telephone Number	:	585-330-2219
Fax Number	:

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	08/15/2011

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