Provider Demographics
NPI:1891832879
Name:COUNTY OF NIAGARA
Entity type:Organization
Organization Name:COUNTY OF NIAGARA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-439-7410
Mailing Address - Street 1:5467 UPPER MOUNTAIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1854
Mailing Address - Country:US
Mailing Address - Phone:716-439-7410
Mailing Address - Fax:716-439-7418
Practice Address - Street 1:5467 UPPER MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1895
Practice Address - Country:US
Practice Address - Phone:716-439-7410
Practice Address - Fax:716-439-7410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIAGARA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00618786Medicaid
000512086001OtherBLUE CROSS BLUE SHIELD DB
6308704OtherINDPENDENT HEALTH
000512086001OtherBLUE CROSS BLUE SHIELD DB