Provider Demographics
NPI:1619796331
Name:UPSTATE MUSIC THERAPY CENTER, LLC
Entity type:Organization
Organization Name:UPSTATE MUSIC THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT, MC-BC, CCTP
Authorized Official - Phone:585-738-1717
Mailing Address - Street 1:401 PENBROOKE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2041
Mailing Address - Country:US
Mailing Address - Phone:585-377-1000
Mailing Address - Fax:
Practice Address - Street 1:401 PENBROOKE DR BLDG 3
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2041
Practice Address - Country:US
Practice Address - Phone:585-377-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)