Provider Demographics
NPI:1114194511
Name:FAVATA, MARGARET RUTH (LPCC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:RUTH
Last Name:FAVATA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 GLEASON CIR
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-2338
Mailing Address - Country:US
Mailing Address - Phone:716-785-2730
Mailing Address - Fax:
Practice Address - Street 1:206 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1110
Practice Address - Country:US
Practice Address - Phone:716-785-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional