Healthcare Provider Details

I. General information

NPI: 1194490011
Provider Name (Legal Business Name): HERRA KAMRAN MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E RIDGE RD
ROCHESTER NY
14621-1297
US

IV. Provider business mailing address

490 E RIDGE RD
ROCHESTER NY
14621-1297
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2500
  • Fax:
Mailing address:
  • Phone: 585-922-2500
  • Fax: 585-922-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: