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NPI Code Detail

MEDICARE: MENTAL HEALTH SERVICES-ERIE COUNTY NORTHWEST CORPORATION I

MEDICARE: MENTAL HEALTH SERVICES-ERIE COUNTY NORTHWEST CORPORATION I
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

Other Identifiers

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

General Provider Information

NPI Number : 1679698286
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENTAL HEALTH SERVICES-ERIE COUNTY NORTHWEST CORPORATION I
Provider Business Mailing Address
First Line : PO BOX 710
Second Line :
City : KENMORE
State : NY
Zip : 14217-0710
Country : US
Telephone Number : 716-882-2127
Fax Number : 716-882-9277
Provider Business Practice Location Address
First Line : 2495 ELMWOOD AVE
Second Line :
City : KENMORE
State : NY
Zip : 14217-2222
Country : US
Telephone Number : 716-882-2127
Fax Number : 716-882-9277
Authorized Official
Title or Position : FINANCE DIRECTOR
Name : MR. DANIEL CHURCH
Credential : MBA
Telephone Number : 716-882-2127
Provider Enumeration Date : 03/20/2007
Last Update Date : 01/31/2022

Similar Medicare Providers

1003755224 — DANIELLE SCOTT
Practice Location Address:
2495 ELMWOOD AVE
KENMORE, NY
14217-2222
Practice Phone: 716-882-2127
Practice Fax:
1295296903 — MARK M SHAW
Practice Location Address:
2495 ELMWOOD AVE
KENMORE, NY
14217-2222
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1306404009 — BARBARA WELDON
Practice Location Address:
2495 ELMWOOD AVE
KENMORE, NY
14217-2222
Practice Phone: 716-871-7092
Practice Fax: 716-871-0275
1972131647 — MR. DAVID F PERFETTE MSW
Practice Location Address:
2495 ELMWOOD AVE
KENMORE, NY
14217-2222
Practice Phone: 716-882-2127
Practice Fax:
1245815976 — ALEXANDRA BREZINSKY
Practice Location Address:
2495 ELMWOOD AVE
KENMORE, NY
14217-2222
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Practice Fax:
1619642204 — ASHLEY A MECCA
Practice Location Address:
2495 ELMWOOD AVE
KENMORE, NY
14217-2222
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Practice Fax:

Directions to “MENTAL HEALTH SERVICES-ERIE COUNTY NORTHWEST CORPORATION I ” Practice Location

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