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75 Genesee St Ste 4 Auburn NY 13021-3644 | |
| (315) 253-9786 | |
| (315) 253-7502 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 75 Genesee St, Auburn, New York |
| Authorized Official Name and Position | Kevin D Hares (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3152539786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
75 Genesee St Ste 4 Auburn NY 13021-3644 Ph: (315) 253-9786 | 75 Genesee St Ste 4 Auburn NY 13021-3644 Ph: (315) 253-9786 |
| NPI Number | 1366456329 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366456329 | NPI | - | NPPES |
| 00949853 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (New York) | Primary |
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