Healthcare Provider Details

I. General information

NPI: 1235428756
Provider Name (Legal Business Name): GENESEE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ALEXANDER ST
ROCHESTER NY
14607-4000
US

IV. Provider business mailing address

224 ALEXANDER ST
ROCHESTER NY
14607-4000
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-7263
  • Fax:
Mailing address:
  • Phone: 585-922-7263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number078515
License Number StateNY

VIII. Authorized Official

Name: DEBRA MCKNIGHT
Title or Position: PRIMARY THERAPIST
Credential: LMSW
Phone: 585-922-7263