Provider Demographics
NPI:1003280728
Name:MOHAWK VALLEY PSYCH CENTER
Entity Type:Organization
Organization Name:MOHAWK VALLEY PSYCH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMHN
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-738-4023
Mailing Address - Street 1:1400 NOYES STREET
Mailing Address - Street 2:#49
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502
Mailing Address - Country:US
Mailing Address - Phone:315-738-4023
Mailing Address - Fax:
Practice Address - Street 1:1400 NOYES STREET
Practice Address - Street 2:#49
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-738-4023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY359951283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital