Provider Demographics
NPI:1902138043
Name:THE BEREAVEMENT CENTER, INC.
Entity Type:Organization
Organization Name:THE BEREAVEMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-765-0456
Mailing Address - Street 1:2310 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5810
Mailing Address - Country:US
Mailing Address - Phone:315-765-0456
Mailing Address - Fax:315-765-0457
Practice Address - Street 1:2310 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5810
Practice Address - Country:US
Practice Address - Phone:315-765-0456
Practice Address - Fax:315-765-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-30
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty