Healthcare Provider Details

I. General information

NPI: 1831284819
Provider Name (Legal Business Name): ONTARIO COUNTY SUBSTANCE ABUSE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 COUNTY COMPLEX DRIVE
CANANDAIGUA NY
14424-9884
US

IV. Provider business mailing address

3019 COUNTY COMPLEX DRIVE
CANANDAIGUA NY
14424-9884
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-4190
  • Fax: 585-393-2916
Mailing address:
  • Phone: 585-396-4190
  • Fax: 585-393-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number061110915
License Number StateNY

VIII. Authorized Official

Name: MS. JUNE ELIZABETH FISHER
Title or Position: DIRECTOR
Credential: LMSW, CASAC
Phone: 585-396-4190