MEDICARE: NYS OFFICE OF MENTAL HEALTH

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	NY
2	3336S0011X	Specialty Pharmacy	NY
3	261QM0850X	Adult Mental Health Clinic/Center	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1336206549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYS OFFICE OF MENTAL HEALTH

Provider Business Mailing Address
First Line	:	44 HOLLAND AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12229-0001
Country	:	US
Telephone Number	:	518-473-3598
Fax Number	:	518-473-5167

Provider Business Practice Location Address
First Line	:	1500 WATERS PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2723
Country	:	US
Telephone Number	:	718-931-0600
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, FINANCE
Name	:	BETH GIARRUSSO
Credential	:
Telephone Number	:	518-473-3598

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	04/19/2017

1500 WATERS PLACE , BUILDING 13 BRONX PSYCHIATRIC CENTER
BRONX, NY
10461-2723

Practice Phone: 718-904-0026
Practice Fax: 718-823-2048