Provider Demographics
NPI:1902816598
Name:HAMBURG COUNSELING SERVICE, INC.
Entity Type:Organization
Organization Name:HAMBURG COUNSELING SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIZANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-648-0650
Mailing Address - Street 1:97 S BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-6212
Mailing Address - Country:US
Mailing Address - Phone:716-648-0650
Mailing Address - Fax:716-648-0666
Practice Address - Street 1:97 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-6212
Practice Address - Country:US
Practice Address - Phone:716-648-0650
Practice Address - Fax:716-648-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
NY261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00671792Medicaid
NY11482AOtherMEDICARE PTAN
NY11482AOtherMEDICARE PTAN