Healthcare Provider Details

I. General information

NPI: 1770787079
Provider Name (Legal Business Name): KIDS ONEIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAIN STREET KIDS ONEIDA, INC.
UTICA NY
13501-1236
US

IV. Provider business mailing address

310 MAIN STREET KIDS ONEIDA, INC.
UTICA NY
13501-1236
US

V. Phone/Fax

Practice location:
  • Phone: 315-731-2607
  • Fax: 315-792-9578
Mailing address:
  • Phone: 315-731-2607
  • Fax: 315-792-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1770787079
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1770787079
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number9063120A
License Number StateNY

VIII. Authorized Official

Name: MR. ROBERT J. ROBERTS
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 315-731-2645