Provider Demographics
NPI:1174653216
Name:ONTARIO COUNTY EARLY INTERVENTION
Entity Type:Organization
Organization Name:ONTARIO COUNTY EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ONTARIO COUNTY PUBLIC H
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEER
Authorized Official - Suffix:
Authorized Official - Credentials:RN MPH
Authorized Official - Phone:585-396-4343
Mailing Address - Street 1:3019 COUNTY COMPLEX DRIVE
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9505
Mailing Address - Country:US
Mailing Address - Phone:585-396-4343
Mailing Address - Fax:585-396-4551
Practice Address - Street 1:3019 COUNTY COMPLEX DRIVE
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9505
Practice Address - Country:US
Practice Address - Phone:585-396-4343
Practice Address - Fax:585-396-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355853Medicaid