Provider Demographics
NPI:1497828461
Name:HARMONIA COLLABORATIVE CARE INC
Entity Type:Organization
Organization Name:HARMONIA COLLABORATIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HEBERT-BUBLYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-947-5025
Mailing Address - Street 1:6722 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047
Mailing Address - Country:US
Mailing Address - Phone:716-947-5025
Mailing Address - Fax:716-947-5909
Practice Address - Street 1:6722 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047
Practice Address - Country:US
Practice Address - Phone:716-947-5025
Practice Address - Fax:716-947-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00671807Medicaid
NY005697Medicare ID - Type Unspecified