Healthcare Provider Details

I. General information

NPI: 1891820171
Provider Name (Legal Business Name): FAMILY SERVICE OF THE CHAUTAUQUA REGION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 E 4TH ST
JAMESTOWN NY
14701-5502
US

IV. Provider business mailing address

332 E 4TH ST
JAMESTOWN NY
14701-5502
US

V. Phone/Fax

Practice location:
  • Phone: 716-488-1971
  • Fax: 716-488-9198
Mailing address:
  • Phone: 716-488-1971
  • Fax: 716-488-9198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMES MCELRATH JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW-R
Phone: 716-488-1971