Provider Demographics
NPI:1194887802
Name:CARDELLA, LAURA HENRICHS (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:HENRICHS
Last Name:CARDELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:HENRICHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:315 SCIENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4257
Mailing Address - Country:US
Mailing Address - Phone:585-279-7809
Mailing Address - Fax:585-256-1901
Practice Address - Street 1:315 SCIENCE PKWY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4257
Practice Address - Country:US
Practice Address - Phone:585-279-7809
Practice Address - Fax:585-256-1901
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602506212084P0800X
NY2506212084P0804X
NY60-2506212084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03163233Medicaid