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General NPI Number Information
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NPI Number | 1346414224
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH SERVICES OF ERIE COUNTY SECV
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | 2040 SENECA ST
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City | BUFFALO
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State | NY
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Zip | 14210-2324
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Country | US
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Telephone | 716-828-0560
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Fax | 716-828-1522
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Provider Business Mailing Address
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Address Line | 227 THORN AVE BOX 631
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2600
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Country | US
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Telephone | 716-662-2040
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Fax | 716-662-0019
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | BRUCE NISBET
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Credential |
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Telephone | 716-662-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 080110870
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License Number State | NY
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