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General NPI Number Information
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NPI Number | 1376895938
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Entity Type | Organization
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Legal Business Name | NYS-OMH @SLPC-CHILDREN & YOUTH
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | ONE CHIMNEY POINT DRIVE
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City | OGDENSBERG
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State | NY
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Zip | 13669-2291
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Country | US
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Telephone | 315-541-2590
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Fax |
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Provider Business Mailing Address
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Address Line | ONE CHIMNEY POINT DRIVE
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City | OGDENSBERG
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State | NY
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Zip | 13669-2291
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Country | US
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Telephone | 315-541-2590
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Fax |
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Authorized Official
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Title or Position | CHIEF OF CHILDREN & YOUTH SERVICES
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Name | CAROL A BREW
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Credential | MS, CAGS
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Telephone | 315-541-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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