=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841340569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF NIAGARA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 07/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 ELEVENTH STREET TROTT ACCESS CENTER
-----------------------------------------------------
City | NIAGARA FALLS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 14301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-278-1940
-----------------------------------------------------
Fax | 716-278-1943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 ELEVENTH STREET ROOM 2021 TROTT ACCESS CENTER
-----------------------------------------------------
City | NIAGARA FALLS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 14301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-278-1940
-----------------------------------------------------
Fax | 716-278-1943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECT OF MENTAL HEALTH
-----------------------------------------------------
Name | LAURA KELEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-439-7410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------