Healthcare Provider Details

I. General information

NPI: 1275448292
Provider Name (Legal Business Name): HEAVEN SENT PEER SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 FONTANA LN
ROCHESTER NY
14612-2973
US

IV. Provider business mailing address

27 FONTANA LN
ROCHESTER NY
14612-2973
US

V. Phone/Fax

Practice location:
  • Phone: 585-664-9037
  • Fax:
Mailing address:
  • Phone: 585-664-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MELISSA CARO
Title or Position: PEER SPECIALIST
Credential: NYCPS,FPA,CRPA
Phone: 585-664-9037