Basic Information
| Provider Information | |||||||||
| NPI: | 1699226670 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCHESTER MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 E RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146211229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859222500 | ||||||||
| FaxNumber: | 5859222684 | ||||||||
| Practice Location | |||||||||
| Address1: | 490 E RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146211229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859222500 | ||||||||
| FaxNumber: | 5859222684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | LOUIS | ||||||||
| AuthorizedOfficialFirstName: | MATHURINE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRIMARY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5859222522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MASTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.