Healthcare Provider Details

I. General information

NPI: 1336328129
Provider Name (Legal Business Name): WAYNE BEHAVIORAL HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD
LYONS NY
14489-9133
US

IV. Provider business mailing address

1519 NYE RD
LYONS NY
14489-9133
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5722
  • Fax: 315-946-7110
Mailing address:
  • Phone: 315-946-5722
  • Fax: 315-946-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. CARMEN V. OCASIO
Title or Position: ASSISTANT SOCIAL WORKER
Credential: M.D.
Phone: 315-946-5722