Basic Information
| Provider Information | |||||||||
| NPI: | 1114107489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLFSON | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | CRC, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 823 RT 13 N | ||||||||
| Address2: | MADISON-CORTLAND ARC ALTERNATIVES CLINIC | ||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077588850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 823 RT 13 N | ||||||||
| Address2: | MADISON-CORTLAND ARC ALTERNATIVES CLINIC | ||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077588850 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2007 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225C00000X | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.