Provider Demographics
NPI: | 1356663223 |
---|---|
Name: | MICHELLE KWINTNER |
Entity Type: | Organization |
Organization Name: | MICHELLE KWINTNER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | THERAPIST |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KWINTNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW-R |
Authorized Official - Phone: | 607-592-4134 |
Mailing Address - Street 1: | 120 E BUFFALO ST |
Mailing Address - Street 2: | STE. 7 |
Mailing Address - City: | ITHACA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14850-4266 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 607-592-4134 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 120 E BUFFALO ST |
Practice Address - Street 2: | STE. 7 |
Practice Address - City: | ITHACA |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14850-4266 |
Practice Address - Country: | US |
Practice Address - Phone: | 607-592-4134 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-02-19 |
Last Update Date: | 2012-09-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 076591 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |