Provider Demographics
NPI:1235184235
Name:ONONDAGA CASE MANAGEMENT SERVICES INC.
Entity Type:Organization
Organization Name:ONONDAGA CASE MANAGEMENT SERVICES INC.
Other - Org Name:CIRCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:EBNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-472-7363
Mailing Address - Street 1:620 ERIE BLVD W STE 302
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2463
Mailing Address - Country:US
Mailing Address - Phone:315-472-7363
Mailing Address - Fax:315-472-0084
Practice Address - Street 1:620 ERIE BLVD W STE 302
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2463
Practice Address - Country:US
Practice Address - Phone:315-472-7363
Practice Address - Fax:315-472-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVARIOUS THERAPISTS103T00000X
NYVARIOUS103TP0016X
NYVARIOUS LICENSES104100000X
NYNOT LICENSED IN NYS251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02382218Medicaid
NY02994838Medicaid
NY8044479AOtherCASE MANAGEMENT OMH-OPERATING CERTIFICATE
NY02717628Medicaid
NY8044025AOtherBEHAVIORAL HEALTH CLINIC-OMH OPERATING CERTIFICATE
NY01212142Medicaid
BA1047OtherMCR PTAN