Provider Demographics
NPI:1881991529
Name:GFN PSYCHOLOGICAL SERVICES, PC
Entity type:Organization
Organization Name:GFN PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NNAJI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-304-5930
Mailing Address - Street 1:6701 MANLIUS CENTER RD
Mailing Address - Street 2:SUITE 111-192
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2999
Mailing Address - Country:US
Mailing Address - Phone:315-218-6377
Mailing Address - Fax:315-218-6377
Practice Address - Street 1:6701 MANLIUS CENTER RD
Practice Address - Street 2:SUITE 111-192
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2999
Practice Address - Country:US
Practice Address - Phone:315-218-6377
Practice Address - Fax:315-218-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018892261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1154623395Medicaid
NY1154623395Medicaid
NY1154623395Medicare Oscar/Certification
NY1154623395Medicare PIN
NY1154623395Medicare NSC