Provider Demographics
NPI:1174258966
Name:PERROTTA, STACEY MAE (NP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MAE
Last Name:PERROTTA
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 CRITTENDEN BLVD BOX PSYCH
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-4501
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-4501
Practice Address - Fax:585-273-1130
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY4041532084P0804X
NYF404153-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry