Healthcare Provider Details

I. General information

NPI: 1114648276
Provider Name (Legal Business Name): HENRIETTA PSYCHIATRIC NP CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250-B LUCIUS GORDON DRIVE SUITE 2
WEST HENRIETTA NY
14586
US

IV. Provider business mailing address

250 LUCIUS GORDON DR STE 2
WEST HENRIETTA NY
14586-9662
US

V. Phone/Fax

Practice location:
  • Phone: 585-471-3407
  • Fax: 866-557-9530
Mailing address:
  • Phone: 585-471-3407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA BAKER
Title or Position: OWNER
Credential: NP
Phone: 585-471-3407