Stanley Long Dba Harbor Lights Professional Chemical Dependency Servic

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

080211024 Issued in NY

Legal business name

STANLEY LONG DBA HARBOR LIGHTS PROFESSIONAL CHEMICAL DEPENDENCY SERVIC

Practice address

3358 Main St
Mexico, NY 13114

Phone

(315) 963-0777

Fax

(345) 963-0611

NPI assigned

Aug 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Stanley E Long

Title

Owner

Phone

(315) 963-0777

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1164435244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 716",
            "address_2": "3358 MAIN ST",
            "city": "MEXICO",
            "state": "NY",
            "postal_code": "13114",
            "telephone_number": "315-963-0777",
            "fax_number": "345-963-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3358 MAIN ST",
            "city": "MEXICO",
            "state": "NY",
            "postal_code": "13114",
            "telephone_number": "315-963-0777",
            "fax_number": "345-963-0611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANLEY LONG DBA HARBOR LIGHTS PROFESSIONAL CHEMICAL DEPENDENCY SERVIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-963-0777",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NY",
            "license": "080211024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01463294",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Shein
• Paul Albert Smith Jr.
• Michael Reyne Soucy, D.C.
• Alex Southwell
• Karen A Spink, RN
• Elizabeth Stewart
• David M Sugar, SLP
• Ashlee M Thompson, OTR/L
• Jessica Lynne Thompson, RN
• Jessica Truesdell, DPT

• Substance Use Disorder Rehabilitation Clinic/Center in Mexico, NY
• Providers in Mexico, NY by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.