DR. HENRY E CRETELLA (NPI# 1659343846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659343846 |
| Entity Type | Individual |
| Full Name | DR. HENRY E CRETELLA |
| Credential | M.D. |
| Practice Address |
243 Center St Canandaigua NY 14424-2101 |
| Mailing Address |
16 Larchwood Dr Pittsford NY 14534-2434 |
| Practice Telephone | 5854243390 |
| Practice Fax Number | 5852728986 |
| Mailing Telephone | 5852480427 |
| Mailing Fax Number | 5852239241 |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2011-10-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
130292 | NY | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
130292 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | STATE EDUCATION DEPT # | 60130292 | 01 |
| Street Address |
243 CENTER ST |
| City | CANANDAIGUA |
| State | NY |
| Zip Code | 14424-2101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467817346 | Kristin Koberstein | Marriage & Family Therapist | 243 Center St, Canandaigua, NY 14424-2101 | 2015-12-21 |
| 1134488430 | Doyle Pruitt | Social Worker | 243 Center St, Canandaigua, NY 14424-2101 | 2012-05-08 |
| 1194939801 | Kristin L. Koberstein | Marriage & Family Therapist | 243 Center St, Canandaigua, NY 14424-2101 | 2007-05-10 |
| 1598891145 | Richard Arthur Hamling | Counselor | 243 Center St, Canandaigua, NY 14424-2101 | 2007-02-26 |
| 1003884115 | Jennifer Heberle Barnes | Chiropractor | 243 Center St, Suite 2, Canandaigua, NY 14424-2101 | 2006-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730725029 | Stefanie Ann Hook | Nurse Practitioner | 395 West Street, Suite 101, Canandaigua, NY 14424 | 2019-11-21 |
| 1285120618 | Mary Kathleen Woodruff | Counselor | 163 Gibson Street, Canandaigua, NY 14424 | 2018-07-09 |
| 1699260612 | Victoria Record | Nurse Practitioner | 3325 Marvin Sands Dr, Canandaigua, NY 14424 | 2018-06-22 |
| 1649767443 | Liana Irene Schenk | Counselor | 5297 Parkside Drive, Building 400, Suite 408, Canandaigua, NY 14424 | 2018-04-17 |
| 1225534019 | Brook Slaby | Counselor | 5297 Parkside Dr Building 400 Office 411, Canandaigua, NY 14424 | 2018-04-02 |
| 1154839710 | Madasyn Leigh Smith | Physical Therapist | 229 Parrish St Ste 220, Canandaigua, NY 14424 | 2018-01-17 |
| 1295259992 | Melissa Ann Frarey | Licensed Practical Nurse | 4998 Wyffels Road, Canandaigua, NY 14424 | 2017-08-03 |
| 1235674599 | Wendy Williams | Early Intervention Provider Agency | 5145 North Bloomfiled Road, Canandaigua, NY 14424 | 2016-12-22 |
| 1326418252 | Mary Christine Casella | Registered Nurse | 90 West Gibson Street, Canandaigua, NY 14424 | 2015-10-05 |
| 1417351453 | Holly Jean Jackson | Licensed Practical Nurse | 5a Lafayette Avenue, Canandaigua, NY 14424 | 2014-10-20 |
| Find all providers in zip 14424 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
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|---|---|---|---|---|
| 1093327611 | Adel Mostafavi, Md PC | Psychiatry & Neurology | 104 W 40th St Rm 400, New York, NY 10018-3692 | 2020-08-17 |
| 1023632015 | Child and Adult Clinical Psychiatry PC | Psychiatry & Neurology | 75 Prospect St Ste 110, Huntington, NY 11743-3320 | 2020-06-04 |
| 1598306441 | Place of Mind Child, Adolescent, and Adult Psychiatry P.C. | Psychiatry & Neurology | 240 Central Park S Apt 2h, New York, NY 10019-1435 | 2019-10-02 |
| 1881102267 | Park Avenue Physicians PC | Psychiatry & Neurology | 5 W 86th St Apt 1b, New York, NY 10024-3663 | 2018-01-19 |
| 1518478080 | Diego G. Calabria Physician P.C. | Psychiatry & Neurology | 366 N Broadway Ste 304, Jericho, NY 11753-2000 | 2017-10-23 |
| 1013426865 | Bebsy Estefan Md PC | Psychiatry & Neurology | 3050 Corlear Ave # Phb, Bronx, NY 10463-5180 | 2017-09-25 |
| 1902281629 | Derek Rudge | Psychiatry & Neurology | 1051 Riverside Dr Rm 235, New York, NY 10032-1007 | 2015-07-23 |
| 1275918096 | Dr Omar Bashayan Physician Pllc | Psychiatry & Neurology | 155 W 68th St Apt 1102, New York, NY 10023-5816 | 2015-07-22 |
| 1740676766 | Maura E Tappen | Psychiatry & Neurology | 1860 South Ave, Rochester, NY 14620-4229 | 2015-04-07 |
| 1194119560 | Krishen Persaud | Psychiatry & Neurology | Stony Brook Psychiatric Associates, Ufpc, Sbumc, Hsc Level 10, Rm.020, Stony Brook, NY 11794-8101 | 2015-03-24 |
| Find all providers with the same taxonomy | ||||
| City | CANANDAIGUA |
| Zip Code | 14424 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.