Provider Demographics
NPI:1760728000
Name:RUSH HENRIETTA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:RUSH HENRIETTA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-359-5122
Mailing Address - Street 1:4000 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9704
Practice Address - Country:US
Practice Address - Phone:585-359-5122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497492Medicaid