Healthcare Provider Details

I. General information

NPI: 1225400187
Provider Name (Legal Business Name): SENECA ONTARIO COMMUNITY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NORTH PARK STREET SENECA ONTARIO COMMUNITY SERVICES
SENECA FALLS NY
13148
US

IV. Provider business mailing address

12 N PARK ST
SENECA FALLS NY
13148-1437
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-9412
  • Fax: 315-568-6718
Mailing address:
  • Phone: 315-568-9412
  • Fax: 315-568-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number3570148A
License Number StateNY

VIII. Authorized Official

Name: MS. NORMA LEONE
Title or Position: RN
Credential:
Phone: 315-568-9412