Healthcare Provider Details

I. General information

NPI: 1699226670
Provider Name (Legal Business Name): ROCHESTER MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E RIDGE RD
ROCHESTER NY
14621-1229
US

IV. Provider business mailing address

490 E RIDGE RD
ROCHESTER NY
14621-1229
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2500
  • Fax: 585-922-2684
Mailing address:
  • Phone: 585-922-2500
  • Fax: 585-922-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. MATHURINE M. LOUIS
Title or Position: PRIMARY THERAPIST
Credential: MASTER
Phone: 585-922-2522