Healthcare Provider Details

I. General information

NPI: 1225210677
Provider Name (Legal Business Name): MENTAL HEALTH SERVICES OF ERIE COUNTY, SOUTHEAST CORP. V
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 MAIN ST THIRD FLOOR
BUFFALO NY
14209-1912
US

IV. Provider business mailing address

227 THORN AVE BOX 631
ORCHARD PARK NY
14127-2600
US

V. Phone/Fax

Practice location:
  • Phone: 716-842-6713
  • Fax: 716-842-0988
Mailing address:
  • Phone: 716-662-2040
  • Fax: 716-662-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRUCE C NISBET
Title or Position: PRESIDENT/CEO
Credential:
Phone: 716-662-2040