Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 012566 | NY |
N | 103T00000X | Psychologist | 012566 | NY |
Y | 103G00000X | Clinical Psychologist | 012566 | NY |
Y | 103TC0700X | Clinical Psychologist | 012566 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 012566 | NY |
N | 103TF0000X | Family Psychologist | 012566 | NY |
NPI | 1134281777 |
---|---|
Provider Name | Dr. Mary E. Olsen-Lanzafame |
First Address | Pittsford, NY 14534-2131 |
Second Address | Pittsford, NY 14534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 28/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7799323 | AETNA PROVIDER ID (01) | NM |
MDF487 | PREFERRED CARE PROV ID (01) | NY |
P010012566 | BLUE CHOICE PROVIDER ID (01) | NY |
P040012566 | BCBS PROVIDER ID (01) | NY |