Individual
MRS. ANITA CONVERTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
312 ELM ST, FAYETTEVILLE, NY 13066-1414
(315) 476-4050
(315) 425-7268
Mailing address
312 ELM ST, FAYETTEVILLE, NY 13066-1414
(315) 476-4050
(315) 425-7268
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
R0438231
NY
Other
Enumeration date
01/31/2007
Last updated
09/24/2009
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