Provider Demographics
NPI:1043741036
Name:DENHAM, PATRICIA (CASAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DENHAM
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 STRATHALLAN PARK APT 6
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1541
Mailing Address - Country:US
Mailing Address - Phone:585-546-1271
Mailing Address - Fax:585-546-2607
Practice Address - Street 1:55 TROUP ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2053
Practice Address - Country:US
Practice Address - Phone:585-546-1271
Practice Address - Fax:585-546-2607
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11880101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11880OtherCASAC