Provider Demographics
NPI:1730480179
Name:ST LAWRENCE PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:ST LAWRENCE PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BREW
Authorized Official - Suffix:
Authorized Official - Credentials:CAGS
Authorized Official - Phone:315-541-2590
Mailing Address - Street 1:32735 COUNTY ROUTE 29 STE A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:NY
Mailing Address - Zip Code:13673-4210
Mailing Address - Country:US
Mailing Address - Phone:315-642-3142
Mailing Address - Fax:315-642-3249
Practice Address - Street 1:32735 COUNTY ROUTE 29 STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:NY
Practice Address - Zip Code:13673-4210
Practice Address - Country:US
Practice Address - Phone:315-642-3142
Practice Address - Fax:315-642-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064470283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital