Healthcare Provider Details

I. General information

NPI: 1194272344
Provider Name (Legal Business Name): MAYA PLANT LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 BLOSSOM RD
ROCHESTER NY
14610-1956
US

IV. Provider business mailing address

PO BOX 67861
ROCHESTER NY
14617-7861
US

V. Phone/Fax

Practice location:
  • Phone: 585-420-8696
  • Fax:
Mailing address:
  • Phone: 585-420-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: