NPIMap

Organization Active NPI

Mental Health Services-Erie County Northwest Corporation I

  • Mental Health Counselor
  • Kenmore, NY
National Provider Identifier
1679698286
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MENTAL HEALTH SERVICES-ERIE COUNTY NORTHWEST CORPORATION I
Practice address
2495 Elmwood Ave
Kenmore, NY 14217-2222
Phone
(716) 882-2127
Fax
(716) 882-9277
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

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

Authorized official

Name
Mr. Daniel Church, MBA
Title
Finance Director
Phone
(716) 882-2127

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

2495 Elmwood Ave
Kenmore, NY 14217-2222

Mailing address

PO Box 710
Kenmore, NY 14217-0710
Phone (716) 882-2127

Other practice location 1

406 Vulcan St
Buffalo, NY 14207-1326
Phone (716) 882-2127

Other identifiers 2

IdentifierTypeStateIssuer
02996876MedicaidNY
01556472MedicaidNY

Other names 1

  • Envision Wellness WNY Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040408001227 NY Part B Supplier - Clinic/Group Practice 1658365101 Receives reassigned benefits from 6 practitioners
Practice locations: Buffalo, NY; Kenmore, NY

National Provider Directory

National Provider Directory

Locations

406 Vulcan St
Buffalo, NY 14207
Phone (716) 871-7092

1300 Niagara St
Buffalo, NY 14213
Phone (716) 882-2127

1591 Kenmore Ave
Kenmore, NY 14217
Phone (716) 462-2481

2495 Elmwood Ave
Kenmore, NY 14217
Phone (716) 882-2127

Practitioners & affiliated clinicians

Practitioners 117

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 117

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1679698286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 710",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142170710",
            "telephone_number": "716-882-2127",
            "fax_number": "716-882-9277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 ELMWOOD AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172222",
            "telephone_number": "716-882-2127",
            "fax_number": "716-882-9277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "406 Vulcan St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142071326",
            "country_code": "US",
            "telephone_number": "716-882-2127",
            "fax_number": "716-882-9277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MENTAL HEALTH SERVICES-ERIE COUNTY NORTHWEST CORPORATION I",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "716-882-2127",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02996876",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01556472",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Envision Wellness WNY Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenmore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.