Healthcare Provider Details

I. General information

NPI: 1295100659
Provider Name (Legal Business Name): MC COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 ELMWOOD TER APT C
ROCHESTER NY
14620-3726
US

IV. Provider business mailing address

571 ELMWOOD TER APT C
ROCHESTER NY
14620-3726
US

V. Phone/Fax

Practice location:
  • Phone: 585-802-3561
  • Fax:
Mailing address:
  • Phone: 585-802-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MCKINLEY
Title or Position: FOUNDER
Credential: MS, MHC
Phone: 585-802-3561