Basic Information
| Provider Information | |||||||||
| NPI: | 1679804082 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESEE MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 ALEXANDER ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859227796 | ||||||||
| FaxNumber: | 5859227246 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 ALEXANDER ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859227796 | ||||||||
| FaxNumber: | 5859227246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2010 | ||||||||
| LastUpdateDate: | 01/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCLEOD | ||||||||
| AuthorizedOfficialFirstName: | ANITA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRIMARY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5859227796 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 075981 | NY | Y | Agencies | Community/Behavioral Health |
No ID Information.