Provider Demographics
NPI:1386057222
Name:PETRA PLACE COUNSELING SERVICES
Entity type:Organization
Organization Name:PETRA PLACE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:REED-MACGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LMSW
Authorized Official - Phone:585-730-7777
Mailing Address - Street 1:888 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1111
Mailing Address - Country:US
Mailing Address - Phone:585-730-7777
Mailing Address - Fax:585-730-7779
Practice Address - Street 1:888 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1111
Practice Address - Country:US
Practice Address - Phone:585-730-7777
Practice Address - Fax:585-730-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0816291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty