Provider Demographics
NPI:1114648276
Name:HENRIETTA PSYCHIATRIC NP CARE, PLLC
Entity Type:Organization
Organization Name:HENRIETTA PSYCHIATRIC NP CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:585-471-3407
Mailing Address - Street 1:250 LUCIUS GORDON DR STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9662
Mailing Address - Country:US
Mailing Address - Phone:585-471-3407
Mailing Address - Fax:
Practice Address - Street 1:250-B LUCIUS GORDON DRIVE SUITE 4B
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586
Practice Address - Country:US
Practice Address - Phone:585-471-3407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02184494Medicaid