MID ERIE MENTAL HEALTH SERVICES INC

Provider Demographics

• NPI: 1225095201
• Name: MID ERIE MENTAL HEALTH SERVICES INC
• Entity Type: Organization
• Organization Name: MID ERIE MENTAL HEALTH SERVICES INC
• Other - Org Name: MID ERIE COUNSELING AND TREATMENT SERVICES
• Other - Org Type: Other Name
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: PATRICK
• Authorized Official - Middle Name: J
• Authorized Official - Last Name: MCINERNEY
• Authorized Official - Credentials: CPA
• Authorized Official - Phone: 716-895-7167
• Mailing Address - Street 1: 1526 WALDEN AVE
• Mailing Address - Street 2: STE 400
• Mailing Address - City: CHEEKTOWAGA
• Mailing Address - State: NY
• Mailing Address - Zip Code: 14225-4965
• Mailing Address - Country: US
• Mailing Address - Phone: 716-895-7167
• Mailing Address - Fax: 716-382-4488
• Practice Address - Street 1: 1526 WALDEN AVE
• Practice Address - Street 2: STE 400
• Practice Address - City: CHEEKTOWAGA
• Practice Address - State: NY
• Practice Address - Zip Code: 14225-4965
• Practice Address - Country: US
• Practice Address - Phone: 716-895-7167
• Practice Address - Fax: 716-382-4488
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-04-26
• Last Update Date: 2014-10-09

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	101Y00000X	Behavioral Health & Social Service Providers	Counselor		Group - Single Specialty
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Single Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	000506023001	Other	COMMUNITY BLUE
	000507788006	Other	BLUE CROSS MENTAL HEALTH
	000525284002	Other	BLUE CROSS MENTAL HEALTH
	000528870001	Other	PPO BLUE CROSS MENTAL H
	0029795	Other	GHI
	8401019	Other	IHA
	00011241001	Other	UNIVERA MEDICAL DOCTOR
	000525283001	Other	BLUE CROSS MENTAL HEALTH
	1131	Other	BLUE CROSS CHD
	000524043001	Other	BLUE CROSS MENTAL HEALTH
	000000859000	Other	PPO BLUE CROSS
	000500635005	Other	BLUE CROSS MENTAL HEALTH
	000000858000	Other	PPO BLUE CROSS
	000081002150	Other	FIDELIS
	000000809000	Other	PPO BLUE CROSS
	1526	Other	BLUE CROSS CHD
	000504008007	Other	BLUE CROSS MENTAL HEALTH
	463	Other	BLUE CROSS CHD
	1526	Other	BLUE CROSS CHD
	463	Other	BLUE CROSS CHD