Provider Demographics
NPI:1477789030
Name:TESTA, MARY LOU (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:TESTA
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TOBEY VILLAGE WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534
Mailing Address - Country:US
Mailing Address - Phone:585-234-0440
Mailing Address - Fax:
Practice Address - Street 1:20 TOBEY VILLAGE WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-234-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18000184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health