MEDICARE: MARILYN K EDDY-SIPEREK 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	101Y00000X	Counselor	000160-1	NY

General Provider Information

NPI Number	:	1962605295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN K EDDY-SIPEREK LMHC

Provider Business Mailing Address
First Line	:	4598 WHALEN RD
Second Line	:
City	:	GREAT VALLEY
State	:	NY
Zip	:	14741-9737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 MAIN ST
Second Line	:
City	:	SALAMANCA
State	:	NY
Zip	:	14779-1529
Country	:	US
Telephone Number	:	716-945-5211
Fax Number	:	716-945-5267

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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