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General NPI Number Information
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NPI Number | 1225095201
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Entity Type | Organization
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Legal Business Name | MID ERIE MENTAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 1526 WALDEN AVE STE 400
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-4965
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Country | US
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Telephone | 716-895-7167
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Fax | 716-382-4488
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Provider Business Mailing Address
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Address Line | 1526 WALDEN AVE STE 400
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-4965
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Country | US
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Telephone | 716-895-7167
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Fax | 716-382-4488
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Authorized Official
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Title or Position | CFO
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Name | PATRICK J MCINERNEY
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Credential | CPA
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Telephone | 716-895-7167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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