Healthcare Provider Details

I. General information

NPI: 1902897374
Provider Name (Legal Business Name): COUNTY OF CHAUTAUQUA - A MUN CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 3RD ST STE 5
JAMESTOWN NY
14701-5433
US

IV. Provider business mailing address

2 ACADEMY ST RM 201
MAYVILLE NY
14757-1050
US

V. Phone/Fax

Practice location:
  • Phone: 716-661-8330
  • Fax: 716-661-8364
Mailing address:
  • Phone: 716-753-4104
  • Fax: 716-753-4230

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 State

VIII. Authorized Official

Name: MR. CARMELO HERNANDEZ
Title or Position: DIR. OF COMM. MENTAL HYGIENE SER
Credential:
Phone: 716-753-4104