Provider Demographics
NPI:1033574009
Name:CAMPS CANANDAIGUA LLC
Entity type:Organization
Organization Name:CAMPS CANANDAIGUA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-905-0061
Mailing Address - Street 1:3200 WEST STREET
Mailing Address - Street 2:500
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424
Mailing Address - Country:US
Mailing Address - Phone:585-905-0061
Mailing Address - Fax:585-412-6612
Practice Address - Street 1:3200 WEST STREET
Practice Address - Street 2:500
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-905-0061
Practice Address - Fax:585-412-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1763162084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty