Provider Demographics
NPI:1659646941
Name:MCAVOY, LEE ANN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANN
Last Name:MCAVOY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 WINTERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4842
Mailing Address - Country:US
Mailing Address - Phone:585-301-6196
Mailing Address - Fax:
Practice Address - Street 1:532 WINTERGREEN WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4842
Practice Address - Country:US
Practice Address - Phone:585-301-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000883 1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health