Provider Demographics
NPI:1073670519
Name:NYS OFFICE OF MENTAL HEALTH
Entity Type:Organization
Organization Name:NYS OFFICE OF MENTAL HEALTH
Other - Org Name:WESTERN NEW YORK CHILDRENS PSYCHIATRIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GIARRUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-473-3598
Mailing Address - Street 1:44 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12229-0001
Mailing Address - Country:US
Mailing Address - Phone:518-473-8234
Mailing Address - Fax:518-473-5167
Practice Address - Street 1:1010 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3602
Practice Address - Country:US
Practice Address - Phone:716-674-9730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00476908Medicaid
NY00476908Medicaid