Provider Demographics
NPI:1033298682
Name:LOPRESTI, CONCHETTA PROVIDENCE (LPC, CASAC, ICCDP)
Entity Type:Individual
Prefix:
First Name:CONCHETTA
Middle Name:PROVIDENCE
Last Name:LOPRESTI
Suffix:
Gender:F
Credentials:LPC, CASAC, ICCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 W HUMBOLDT PKWY
Mailing Address - Street 2:MSGR. CARR INSTITUTE
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2605
Mailing Address - Country:US
Mailing Address - Phone:716-835-9745
Mailing Address - Fax:716-835-6785
Practice Address - Street 1:76 W HUMBOLDT PKWY
Practice Address - Street 2:MSGR. CARR INSTITUTE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2605
Practice Address - Country:US
Practice Address - Phone:716-835-9745
Practice Address - Fax:716-835-6785
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000906101Y00000X
PA4010101YA0400X
NY22683101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5833OtherCO-OCCURRING DISORDERS
PAPC000906OtherPROFESSIONAL COUNSELOR
300099OtherINTERNATIONALLY CERTIFIED CO-OCCURRING DISORDERS PROFESSIONAL
PA4010OtherADDICTIONS COUNSELOR
NY22683OtherADDICTIONS