Provider Demographics
NPI:1417065426
Name:HUMAN TECHNOLOGIES
Entity Type:Organization
Organization Name:HUMAN TECHNOLOGIES
Other - Org Name:MENTAL HEALTH CONNECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARRUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-735-9501
Mailing Address - Street 1:2260 DWYER AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-724-9891
Mailing Address - Fax:315-724-9896
Practice Address - Street 1:1002 BLACK RIVER BLVD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-337-0773
Practice Address - Fax:315-337-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6276110B261QM0801X
NY6276110A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01158465Medicaid
NY01558465Medicaid
NYBA0759Medicare UPIN