Healthcare Provider Details

I. General information

NPI: 1376980185
Provider Name (Legal Business Name): RICHARD ROVET PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3453 W LAKE RD
CANANDAIGUA NY
14424-2467
US

IV. Provider business mailing address

3453 W LAKE RD
CANANDAIGUA NY
14424-2467
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-1956
  • Fax:
Mailing address:
  • Phone: 937-723-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number478025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: