Healthcare Provider Details

I. General information

NPI: 1790853844
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 N CLINTON AVE
ROCHESTER NY
14604-1407
US

IV. Provider business mailing address

79 N CLINTON AVE
ROCHESTER NY
14604-1407
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-7220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number070210700
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9084001A
License Number StateNY

VIII. Authorized Official

Name: KATHLEEN JOHNSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 585-546-7220