Provider Demographics
NPI:1568528065
Name:LEWIS COUNTY COMMUNITY SERVICES BOARD
Entity Type:Organization
Organization Name:LEWIS COUNTY COMMUNITY SERVICES BOARD
Other - Org Name:LEWIS COUNTY COMMUNITY MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-376-5450
Mailing Address - Street 1:7550 SOUTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367
Mailing Address - Country:US
Mailing Address - Phone:315-376-5450
Mailing Address - Fax:315-376-7221
Practice Address - Street 1:7550 S STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1533
Practice Address - Country:US
Practice Address - Phone:315-376-5450
Practice Address - Fax:315-376-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
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
NY00657649Medicaid
NY00657649Medicaid