Provider Demographics
NPI:1043686314
Name:CAYUGA ADDICTION RECOVERY SERVICES
Entity Type:Organization
Organization Name:CAYUGA ADDICTION RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY ADDICTIONS COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL LAMBERT
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:607-273-5500
Mailing Address - Street 1:477 NELSON RD
Mailing Address - Street 2:APARTMENT
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9437
Mailing Address - Country:US
Mailing Address - Phone:607-229-0170
Mailing Address - Fax:
Practice Address - Street 1:334 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5432
Practice Address - Country:US
Practice Address - Phone:607-273-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY095740OtherNYS OFFICE OF THE PROFESSIONS - LMSW