Provider Demographics
NPI:1659862290
Name:MITCHELL J LURYE,LCSWR.LLC
Entity type:Organization
Organization Name:MITCHELL J LURYE,LCSWR.LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LURYE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:585-217-6319
Mailing Address - Street 1:274 N GOODMAN ST STE 283
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1154
Mailing Address - Country:US
Mailing Address - Phone:585-217-6319
Mailing Address - Fax:
Practice Address - Street 1:274 N GOODMAN ST STE 283
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1154
Practice Address - Country:US
Practice Address - Phone:585-217-6319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031120302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization