Provider Demographics
NPI:1831157775
Name:PSYCHIATRIC SERVICES OF CENTRAL NEW YORK
Entity type:Organization
Organization Name:PSYCHIATRIC SERVICES OF CENTRAL NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARNUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-792-7626
Mailing Address - Street 1:502 COURT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4233
Mailing Address - Country:US
Mailing Address - Phone:315-792-7626
Mailing Address - Fax:315-792-7675
Practice Address - Street 1:502 COURT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4233
Practice Address - Country:US
Practice Address - Phone:315-792-7626
Practice Address - Fax:315-792-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2091582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE64587Medicare UPIN