Healthcare Provider Details

I. General information

NPI: 1477878775
Provider Name (Legal Business Name): ELMIRA PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N. PARK ST. SENECA-ONTARIO COMMUNITY SERVICES - 2ND FLOOR
SENECA FALLS NY
13148
US

IV. Provider business mailing address

100 WASHINGTON ST
ELMIRA NY
14901-2849
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-9412
  • Fax: 315-568-6718
Mailing address:
  • Phone: 607-737-4711
  • Fax: 607-737-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number100226
License Number StateMD

VIII. Authorized Official

Name: MR. ANDREW SCOTT MORGAN
Title or Position: REHABILITATION COUNSELOR II
Credential: CPRP
Phone: 315-568-9412