Healthcare Provider Details

I. General information

NPI: 1225095201
Provider Name (Legal Business Name): MID ERIE MENTAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVE STE 400
CHEEKTOWAGA NY
14225-4965
US

IV. Provider business mailing address

1526 WALDEN AVE STE 400
CHEEKTOWAGA NY
14225-4965
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-7167
  • Fax: 716-382-4488
Mailing address:
  • Phone: 716-895-7167
  • Fax: 716-382-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: PATRICK J MCINERNEY
Title or Position: CFO
Credential: CPA
Phone: 716-895-7167