Healthcare Provider Details

I. General information

NPI: 1487983011
Provider Name (Legal Business Name): CATHOLIC FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 N CLINTON AVE
ROCHESTER NY
14604-1455
US

IV. Provider business mailing address

87 N CLINTON AVE
ROCHESTER NY
14604-1455
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-7220
  • Fax: 585-262-7036
Mailing address:
  • Phone: 585-546-7220
  • Fax: 585-262-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003812
License Number StateNY

VIII. Authorized Official

Name: MRS. TINA SIMSON
Title or Position: PROGRAM DIRECTOR
Credential: MS
Phone: 585-546-7220