Provider Demographics
NPI:1942569496
Name:GENESEE MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:GENESEE MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CHILD AND YOUTH SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:EVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-7260
Mailing Address - Street 1:79 1/2 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1139
Mailing Address - Country:US
Mailing Address - Phone:607-351-4257
Mailing Address - Fax:
Practice Address - Street 1:79 1/2 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1139
Practice Address - Country:US
Practice Address - Phone:607-351-4257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCHESTER GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health