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General NPI Number Information
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NPI Number | 1033574009
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Entity Type | Organization
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Legal Business Name | CAMPS CANANDAIGUA LLC
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 3200 WEST STREET 500
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City | CANANDAIGUA
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State | NY
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Zip | 14424
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Country | US
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Telephone | 585-905-0061
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Fax | 585-412-6612
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Provider Business Mailing Address
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Address Line | 3200 WEST STREET 500
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City | CANANDAIGUA
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State | NY
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Zip | 14424
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Country | US
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Telephone | 585-905-0061
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Fax | 585-412-6612
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARILYN RENNIE
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Credential |
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Telephone | 585-905-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | 176316
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License Number State | NY
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