Provider Demographics
NPI:1891012266
Name:PRECIOUS MINDS CHILD/ADULT PSYCHIATRY SERVICES PLLC
Entity type:Organization
Organization Name:PRECIOUS MINDS CHILD/ADULT PSYCHIATRY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MORALES
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-507-2577
Mailing Address - Street 1:2504 GENESEE ST
Mailing Address - Street 2:OFFICE FIRST FL
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5832
Mailing Address - Country:US
Mailing Address - Phone:315-507-2577
Mailing Address - Fax:315-507-2643
Practice Address - Street 1:2504 GENESEE ST
Practice Address - Street 2:OFFICE FIRST FL
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5832
Practice Address - Country:US
Practice Address - Phone:315-507-2577
Practice Address - Fax:315-507-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255046-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03193166Medicaid