1548693005 NPI number — MRS. FAITH MARIE CARINI-GRAVES PMHNP(PSYCHIATRIC)

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548693005 NPI number — MRS. FAITH MARIE CARINI-GRAVES PMHNP(PSYCHIATRIC)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARINI-GRAVES
Provider First Name:
FAITH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP(PSYCHIATRIC)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
FAITH
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PMHNP(PSYCHIATRIC)
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548693005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/15/2022
NPI Reactivation Date:
08/10/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 HOLLYHOCK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14580-9797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
158-536-9246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
695 BAY RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-787-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  312266 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 404233 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)