Provider Demographics
NPI:1841355781
Name:BOMYEA, ORMAN DAVID (CASAC, CPP)
Entity type:Individual
Prefix:MR
First Name:ORMAN
Middle Name:DAVID
Last Name:BOMYEA
Suffix:
Gender:M
Credentials:CASAC, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-0432
Mailing Address - Country:US
Mailing Address - Phone:518-483-8980
Mailing Address - Fax:518-483-4830
Practice Address - Street 1:209 PARK STREET
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-483-8980
Practice Address - Fax:518-483-4830
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3554101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)