| NPI | 1194874610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER PETRUS Executive Director 315-253-9795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 7734100A) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 7734430) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 7734100B) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 7734100C) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 7734300A) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2016-04-28 |