Provider Demographics
NPI:1225758709
Name:WESTSIDE COMMUNITY CARE MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:WESTSIDE COMMUNITY CARE MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:716-474-3563
Mailing Address - Street 1:5 LAND RE WAY APT 36
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1738
Mailing Address - Country:US
Mailing Address - Phone:716-474-3563
Mailing Address - Fax:585-617-4118
Practice Address - Street 1:24 WEST AVE STE 203
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1344
Practice Address - Country:US
Practice Address - Phone:716-474-3563
Practice Address - Fax:585-617-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty