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General NPI Number Information
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NPI Number | 1962875484
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Entity Type | Organization
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Legal Business Name | HUTCHINGS PSYCHIATRIC CENTER
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 650 MADISON ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2319
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Country | US
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Telephone | 315-426-7783
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Fax |
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Provider Business Mailing Address
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Address Line | 650 MADISON ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2319
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Country | US
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Telephone | 315-426-7783
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER II
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Name | MRS. MARY SUSAN CARLISLE
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Credential | LMSW
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Telephone | 315-426-7783
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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 | 076534
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 076534
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License Number State | NY
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