Healthcare Provider Details

I. General information

NPI: 1952268005
Provider Name (Legal Business Name): C. J. HASLAM BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4987 S EAGLE VILLAGE RD
MANLIUS NY
13104-9459
US

IV. Provider business mailing address

4987 S EAGLE VILLAGE RD
MANLIUS NY
13104-9459
US

V. Phone/Fax

Practice location:
  • Phone: 208-286-8062
  • Fax:
Mailing address:
  • Phone: 208-286-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE HASLAM
Title or Position: OWNER
Credential: LCSW
Phone: 208-286-8062