Provider Demographics
NPI:1912179292
Name:ONONDAGA COUNTY DEPARTMENT OF MENTAL HEALTH
Entity Type:Organization
Organization Name:ONONDAGA COUNTY DEPARTMENT OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-435-3355
Mailing Address - Street 1:421 MONTGOMERY STREET
Mailing Address - Street 2:CIVIC CENTER 10TH FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-435-3355
Mailing Address - Fax:315-435-3279
Practice Address - Street 1:520 CEDAR ST
Practice Address - Street 2:DAY TREATMENT PROGRAM - PALMER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2302
Practice Address - Country:US
Practice Address - Phone:315-435-7706
Practice Address - Fax:315-435-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00565031Medicaid