Provider Demographics
NPI:1376895938
Name:NYS-OMH @SLPC-CHILDREN & YOUTH
Entity Type:Organization
Organization Name:NYS-OMH @SLPC-CHILDREN & YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF CHILDREN & YOUTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CAGS
Authorized Official - Phone:315-541-2590
Mailing Address - Street 1:ONE CHIMNEY POINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:OGDENSBERG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-2291
Mailing Address - Country:US
Mailing Address - Phone:315-541-2590
Mailing Address - Fax:
Practice Address - Street 1:ONE CHIMNEY POINT DRIVE
Practice Address - Street 2:
Practice Address - City:OGDENSBERG
Practice Address - State:NY
Practice Address - Zip Code:13669-2291
Practice Address - Country:US
Practice Address - Phone:315-541-2590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital