| Lake Shore Behavioral Health, Inc. | |
|
2600 S Park Ave Lackawanna NY 14218-1504 | |
| (716) 842-0440 | |
| (716) 842-4069 |
| Full Name | Lake Shore Behavioral Health, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2600 S Park Ave, Lackawanna, New York |
| Authorized Official Name and Position | Howard Hitzel (PRESIDENT) |
| Authorized Official Contact | 7168420440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Shore Behavioral Health, Inc. 254 Franklin St Buffalo NY 14202-1902 Ph: (716) 842-0440 | Lake Shore Behavioral Health, Inc. 2600 S Park Ave Lackawanna NY 14218-1504 Ph: (716) 842-0440 |
| NPI Number | 1134331713 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134331713 | NPI | - | NPPES |
| 00671765 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 6783301A (New York) | Primary |
Olv Human Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 780 Ridge Rd, Lackawanna, NY 14218 Phone: 716-828-9500 | |
Baker Victory Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 790 Ridge Road, Lackawanna, NY 14218 Phone: 716-828-9500 |