Provider Demographics
NPI:1437181963
Name:PSYCHIATRIC SERVICES GROUP
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SYSTEMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-1122
Mailing Address - Street 1:490 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1229
Mailing Address - Country:US
Mailing Address - Phone:585-922-2500
Mailing Address - Fax:585-922-2664
Practice Address - Street 1:490 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1229
Practice Address - Country:US
Practice Address - Phone:585-922-2500
Practice Address - Fax:585-922-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01505893Medicaid
NYG0184705590OtherBLUE CROSS
11274AMedicare ID - Type Unspecified