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General NPI Number Information
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NPI Number | 1386057222
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Entity Type | Organization
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Legal Business Name | PETRA PLACE COUNSELING SERVICES
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 888 LONG POND RD
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City | ROCHESTER
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State | NY
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Zip | 14626-1111
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Country | US
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Telephone | 585-730-7777
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Fax | 585-730-7779
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Provider Business Mailing Address
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Address Line | 888 LONG POND RD
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City | ROCHESTER
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State | NY
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Zip | 14626-1111
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Country | US
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Telephone | 585-730-7777
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Fax | 585-730-7779
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. STACEY M REED-MACGREGOR
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Credential | MSW LMSW
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Telephone | 585-730-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 081629
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License Number State | NY
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