Healthcare Provider Details

I. General information

NPI: 1811422538
Provider Name (Legal Business Name): CATHOLIC FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
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: 585-232-5703
Mailing address:
  • Phone: 585-546-7220
  • Fax: 585-232-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number296049
License Number StateNY

VIII. Authorized Official

Name: KRISTIE ELIAS
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 585-546-7220