Provider Demographics
NPI:1255594503
Name:THE CENTER FOR FAMILY THERAPY
Entity type:Organization
Organization Name:THE CENTER FOR FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-RCASAC
Authorized Official - Phone:716-434-7430
Mailing Address - Street 1:580 BEWLEY BUILDING
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-2944
Mailing Address - Country:US
Mailing Address - Phone:716-434-7430
Mailing Address - Fax:716-434-2300
Practice Address - Street 1:580 BEWLEY BUILDING
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-2944
Practice Address - Country:US
Practice Address - Phone:716-434-7430
Practice Address - Fax:716-434-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02976411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01594669Medicaid
NY00332774Medicaid
NY11468DMedicare PIN
NY11468AMedicare UPIN
NY11468CMedicare PIN