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General NPI Number Information
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NPI Number | 1114648276
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Entity Type | Organization
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Legal Business Name | HENRIETTA PSYCHIATRIC NP CARE, PLLC
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 250-B LUCIUS GORDON DRIVE SUITE 2
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City | WEST HENRIETTA
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State | NY
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Zip | 14586
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Country | US
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Telephone | 585-471-3407
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Fax | 866-557-9530
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Provider Business Mailing Address
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Address Line | 250 LUCIUS GORDON DR STE 2
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City | WEST HENRIETTA
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State | NY
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Zip | 14586-9662
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Country | US
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Telephone | 585-471-3407
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LAURA BAKER
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Credential | NP
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Telephone | 585-471-3407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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