Healthcare Provider Details

I. General information

NPI: 1497828461
Provider Name (Legal Business Name): HARMONIA COLLABORATIVE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 ERIE RD
DERBY NY
14047
US

IV. Provider business mailing address

6722 ERIE RD
DERBY NY
14047
US

V. Phone/Fax

Practice location:
  • Phone: 716-947-5025
  • Fax: 716-947-5909
Mailing address:
  • Phone: 716-947-5025
  • Fax: 716-947-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNY

VIII. Authorized Official

Name: MONIQUE Y HEBERT-BUBLYK
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 716-947-5025