Provider Demographics
NPI:1205064680
Name:HEATHER MUXWORTHY DNP(S), PMHNP-BC, LLC
Entity type:Organization
Organization Name:HEATHER MUXWORTHY DNP(S), PMHNP-BC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF COMPANY
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MUXWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP(S), PMHNP-BC,
Authorized Official - Phone:585-641-0446
Mailing Address - Street 1:3300 MONROE AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4615
Mailing Address - Country:US
Mailing Address - Phone:585-641-0446
Mailing Address - Fax:585-641-0447
Practice Address - Street 1:3300 MONROE AVE STE 309
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4615
Practice Address - Country:US
Practice Address - Phone:585-641-0446
Practice Address - Fax:585-641-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400539261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)