Provider Demographics
NPI:1750890596
Name:COUNSELING SERVICES OF UPSTATE NEW YORK INC.
Entity type:Organization
Organization Name:COUNSELING SERVICES OF UPSTATE NEW YORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TRETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-285-8070
Mailing Address - Street 1:3900 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-2236
Mailing Address - Country:US
Mailing Address - Phone:716-285-8070
Mailing Address - Fax:
Practice Address - Street 1:950 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1850
Practice Address - Country:US
Practice Address - Phone:716-285-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VENTURE FORTHE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health