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General NPI Number Information
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NPI Number | 1831284819
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Entity Type | Organization
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Legal Business Name | ONTARIO COUNTY SUBSTANCE ABUSE SERVICES
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 3019 COUNTY COMPLEX DRIVE
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City | CANANDAIGUA
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State | NY
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Zip | 14424-9884
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Country | US
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Telephone | 585-396-4190
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Fax | 585-393-2916
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Provider Business Mailing Address
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Address Line | 3019 COUNTY COMPLEX DRIVE
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City | CANANDAIGUA
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State | NY
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Zip | 14424-9884
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Country | US
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Telephone | 585-396-4190
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Fax | 585-393-2916
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JUNE ELIZABETH FISHER
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Credential | LMSW, CASAC
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Telephone | 585-396-4190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 061110915
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License Number State | NY
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