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General NPI Number Information
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NPI Number | 1952080954
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Entity Type | Organization
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Legal Business Name | SERENITY PLACE THERAPY LLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 3445 WINTON PLACE STE. 114
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City | ROCHESTER
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State | NY
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Zip | 14623
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Country | US
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Telephone | 276-224-2043
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Fax |
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Provider Business Mailing Address
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Address Line | 265 S FEDERAL HWY # 285
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-4161
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Country | US
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Telephone | 276-224-2043
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Fax |
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | MRS. PATRICIA A HOUCHIN
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Credential | MA, LMHC
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Telephone | 276-224-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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