MEDICARE: COLEEN M FOSTER 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	041981	NY

General Provider Information

NPI Number	:	1942305636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLEEN M FOSTER LCSW-R

Provider Business Mailing Address
First Line	:	81 LAKE AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14608-1410
Country	:	US
Telephone Number	:	585-368-6900
Fax Number	:	585-423-9523

Provider Business Practice Location Address
First Line	:	81 LAKE AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14608-1410
Country	:	US
Telephone Number	:	585-368-6900
Fax Number	:	585-423-9523

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	11/12/2015

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