Healthcare Provider Details

I. General information

NPI: 1962877688
Provider Name (Legal Business Name): DR. WENDY ROSEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HARVARD STREET
ROCHESTER NY
14607
US

IV. Provider business mailing address

18 HARVARD ST
ROCHESTER NY
14607-2607
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-8180
  • Fax: 585-473-6583
Mailing address:
  • Phone: 585-473-8180
  • Fax: 585-473-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number199182-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number389207-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number42787-1
License Number StateNY

VIII. Authorized Official

Name: ALANNAH MCCARTHY
Title or Position: OFFICE MANAGER
Credential:
Phone: 585-473-8180