Provider Demographics
NPI:1407988751
Name:SACRED HEART HEALING CENTER
Entity Type:Organization
Organization Name:SACRED HEART HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRIVATE PRACTICE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EMETERIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R, BCD
Authorized Official - Phone:315-335-4592
Mailing Address - Street 1:608 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-335-4592
Mailing Address - Fax:315-336-4800
Practice Address - Street 1:310 E. CHESTNUT ST.
Practice Address - Street 2:SUITE 14
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-335-4592
Practice Address - Fax:315-336-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0532891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02514405Medicaid
NYQ04942Medicare UPIN
NY02514405Medicaid