Provider Demographics
NPI:1467795294
Name:GARRICK, IRENE R (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:R
Last Name:GARRICK
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WINTON RD S
Mailing Address - Street 2:BLDG. 4, SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3970
Mailing Address - Country:US
Mailing Address - Phone:585-473-2671
Mailing Address - Fax:585-473-2678
Practice Address - Street 1:2000 WINTON RD S
Practice Address - Street 2:BLDG. 4, SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3970
Practice Address - Country:US
Practice Address - Phone:585-473-2671
Practice Address - Fax:585-473-2678
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health