Healthcare Provider Details

I. General information

NPI: 1366434011
Provider Name (Legal Business Name): FINGER LAKES AREA COUNSELING AND RECOVERY AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 E MAIN ST
CLIFTON SPRINGS NY
14432
US

IV. Provider business mailing address

28 E MAIN ST
CLIFTON SPRINGS NY
14432-1231
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-9466
  • Fax: 315-462-6400
Mailing address:
  • Phone: 315-462-9466
  • Fax: 315-462-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number8481001A
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190312132
License Number StateNY

VIII. Authorized Official

Name: MR. MARTIN TELLER
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 315-462-9466