Provider Demographics
NPI:1073065561
Name:FAMILY SUPPORT IN CENTRAL NEW YORK, INC.
Entity Type:Organization
Organization Name:FAMILY SUPPORT IN CENTRAL NEW YORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PEER ADVOCATE
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GODLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-794-4590
Mailing Address - Street 1:9582 WHITTAKER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND PATENT
Mailing Address - State:NY
Mailing Address - Zip Code:13354-4343
Mailing Address - Country:US
Mailing Address - Phone:315-794-5799
Mailing Address - Fax:315-768-3670
Practice Address - Street 1:155 MADISON ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-1743
Practice Address - Country:US
Practice Address - Phone:315-941-2520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty