Individual
DR. MARY E. OLSEN-LANZAFAME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
121 SULLYS TRL, SUITE 5, PITTSFORD, NY 14534
(585) 732-5310
(585) 495-2146
Mailing address
124 S MAIN ST, PITTSFORD, NY 14534-2131
(585) 732-5310
(585) 495-2146
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
012566
NY
103TC0700X
Clinical Psychologist
Primary
012566
NY
103TC2200X
Clinical Child & Adolescent Psychologist
012566
NY
103TF0000X
Family Psychologist
012566
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7799323
AETNA PROVIDER ID
NM
01
—
MDF487
PREFERRED CARE PROV ID
NY
01
—
P010012566
BLUE CHOICE PROVIDER ID
NY
01
—
P040012566
BCBS PROVIDER ID
NY
Enumeration date
12/13/2006
Last updated
05/28/2018
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