Healthcare Provider Details

I. General information

NPI: 1336206549
Provider Name (Legal Business Name): NYS OFFICE OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERS PL
BRONX NY
10461-2723
US

IV. Provider business mailing address

44 HOLLAND AVE
ALBANY NY
12229-0001
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-0600
  • Fax:
Mailing address:
  • Phone: 518-473-3598
  • Fax: 518-473-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: BETH GIARRUSSO
Title or Position: DIRECTOR, FINANCE
Credential:
Phone: 518-473-3598