Provider Demographics
NPI:1700258159
Name:ST. LAWRENCE PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:ST. LAWRENCE PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMHN - MIT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:ZELEDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-769-8441
Mailing Address - Street 1:23 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1017
Mailing Address - Country:US
Mailing Address - Phone:315-769-8441
Mailing Address - Fax:315-769-3902
Practice Address - Street 1:23 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1017
Practice Address - Country:US
Practice Address - Phone:315-769-8441
Practice Address - Fax:315-769-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY525043283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital