Healthcare Provider Details

I. General information

NPI: 1437181963
Provider Name (Legal Business Name): PSYCHIATRIC SERVICES GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 RIDGE RD E
ROCHESTER NY
14621-1229
US

IV. Provider business mailing address

490 RIDGE RD E
ROCHESTER NY
14621-1229
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2500
  • Fax: 585-922-2664
Mailing address:
  • Phone: 585-922-2500
  • Fax: 585-922-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MAXINE KINARD
Title or Position: BUSINESS SYSTEMS MANAGER
Credential:
Phone: 585-922-1122