Provider Demographics
NPI:1326409020
Name:PETRENKO, CHRISTIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:
Last Name:PETRENKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:187 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2415
Mailing Address - Country:US
Mailing Address - Phone:585-275-2991
Mailing Address - Fax:
Practice Address - Street 1:187 EDINBURGH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2415
Practice Address - Country:US
Practice Address - Phone:585-275-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18988103T00000X
NY018988103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist