| Upstate Cerebral Palsy, Inc. | |
|
1020 Mary St Utica NY 13501-1930 | |
| (315) 724-6907 | |
| (315) 733-0791 |
| Full Name | Upstate Cerebral Palsy, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1020 Mary St, Utica, New York |
| Authorized Official Name and Position | Geno Decondo (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3157246907 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Upstate Cerebral Palsy, Inc. 1020 Mary St Utica NY 13501-1930 Ph: (315) 724-6907 | Upstate Cerebral Palsy, Inc. 1020 Mary St Utica NY 13501-1930 Ph: (315) 724-6907 |
| NPI Number | 1578623617 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 10/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578623617 | NPI | - | NPPES |
| 00474180 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 00474180 (* (Not Available)) | Primary |
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