Provider Demographics
NPI:1609835578
Name:NEW HORIZONS OF THE GENESEE VALLEY, INC.
Entity type:Organization
Organization Name:NEW HORIZONS OF THE GENESEE VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SPEZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:585-624-1350
Mailing Address - Street 1:3 EPISCOPAL AVE
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-6900
Mailing Address - Country:US
Mailing Address - Phone:585-624-1350
Mailing Address - Fax:585-624-9181
Practice Address - Street 1:3 EPISCOPAL AVE
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-6900
Practice Address - Country:US
Practice Address - Phone:585-624-1350
Practice Address - Fax:585-624-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042892-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7215572OtherAETNA
NYRC80042892OtherRCIPA
NYP010042892OtherEXCELLUS
NY118121FKOtherPREFERRED CARE
NY5508792OtherCCN
NY2177484Other1ST HEALTH