Healthcare Provider Details

I. General information

NPI: 1316046113
Provider Name (Legal Business Name): BRIGHT PATH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7266 BUCKLEY RD
NORTH SYRACUSE NY
13212-2649
US

IV. Provider business mailing address

7266 BUCKLEY RD
NORTH SYRACUSE NY
13212-2649
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-0919
  • Fax: 315-458-0954
Mailing address:
  • Phone: 315-458-0919
  • Fax: 315-458-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MISS LORI L COLLINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 315-458-0919