Healthcare Provider Details

I. General information

NPI: 1023369683
Provider Name (Legal Business Name): MONROE YOUTH AND FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HUMBOLDT ST
ROCHESTER NY
14610-1059
US

IV. Provider business mailing address

13 RISING PL
ROCHESTER NY
14607-3846
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-1960
  • Fax:
Mailing address:
  • Phone: 607-368-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number087353-1
License Number StateNY

VIII. Authorized Official

Name: ALICE BERRY
Title or Position: VICE PRESIDENT
Credential:
Phone: 585-546-1960