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Provider Information for 1750748992

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1750748992

Calendar   Last Updated:  2016-01-19
  Certification Date: 


Name Value
NPI 1750748992
Enumeration Date 2016-01-19
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 1832 STATE ROUTE 89
SENECA FALLS, NY 13148-9413
United States

Phone: | Fax:
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Primary Practice Address 17 E GENESEE ST
AUBURN, NY 13021-4040
United States

Phone: 315-253-9795 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 101YM0800X - Counselor Mental Health