Healthcare Provider Details

I. General information

NPI: 1891263984
Provider Name (Legal Business Name): MRS. SOLANA L CRITTENDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 SAINT PAUL ST
ROCHESTER NY
14621-3162
US

IV. Provider business mailing address

1645 SAINT PAUL ST
ROCHESTER NY
14621-3162
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: