# UPSTATE KETAMINE CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710522875
- **Authorized official:** JEFFREY C LEATHERSICH (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (585) 673-2319

## Contact information

- **Practice address:** 3300 MONROE AVE STE 319, ROCHESTER, NY 14618-4617
- **Practice address phone:** (585) 673-2319
- **Mailing address:** 3300 MONROE AVE STE 319, ROCHESTER, NY 14618-4617
- **Mailing address phone:** (585) 673-2319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 364SP0808X | Psychiatric/Mental Health Clinical Nurse Specialist | — | NULL | Yes |
| 364SP0808X | Psychiatric/Mental Health Clinical Nurse Specialist | — | — | Yes |

## Other

- **Enumeration date:** 11/13/2019
- **Last updated:** 11/13/2019