1639251358 NPI number — CHILD AND FAMILY SERVICES

Table of content: (NPI 1639251358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639251358 NPI number — CHILD AND FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILD AND FAMILY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639251358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14202-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-842-2750
Provider Business Mailing Address Fax Number:
716-842-0668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14202-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-842-2750
Provider Business Practice Location Address Fax Number:
716-842-0668
Provider Enumeration Date:
10/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVID
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
SENIOR MENTAL HEALTH CLINICIAN
Authorized Official Telephone Number:
716-842-2750

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  R034454-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00034454 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000525335001 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".