Provider Demographics
NPI:1568570042
Name:COLE-RISTUCCIA, LAVERN K (PSY D PC)
Entity Type:Individual
Prefix:DR
First Name:LAVERN
Middle Name:K
Last Name:COLE-RISTUCCIA
Suffix:
Gender:F
Credentials:PSY D PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S PITTSFORD HILL LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-507-2181
Mailing Address - Fax:585-385-9315
Practice Address - Street 1:5 S PITTSFORD HILL LANE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2894
Practice Address - Country:US
Practice Address - Phone:585-507-2181
Practice Address - Fax:585-385-9315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY012985103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010012985OtherBCBS
NYP010012985OtherBLUE CHOICE
NYP102037FCOtherPREFERRED CARE
NY01733782Medicaid