Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 001564-1 | NY |
NPI | 1174182182 |
---|---|
Provider Name | Roberta Yvonne Lindner-Ciopyk |
First Address | Clyde, NY 14433-9724 |
Second Address | Waterloo, NY 13165-1665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 12/06/2019 |