Certified Chemical Dependence Treatment Providers
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Transcript of Certified Chemical Dependence Treatment Providers
Certified Chemical Dependence
Treatment Providers
January 31, 2022As of
Division of Quality Assurance and Performance
Improvement
Bureau of Certification
Listing of
Janet L. Paloski, Director, Bureau of Certification
820 River St., Inc.
Mr. Peter Newkirk, Chief Executive Officer
428 Duane Avenue, Schenectady, NY 12304
Provider Number: 35210
Administrative Office:
Telephone - (518)-377-4228 Ext 202
Certificate Number: 181210136
111-113 Second Avenue, , Troy, New York 12180
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819) 14Service Type:
Program Name:
Certified Capacity:PRU 50863
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10136_820Riv.pdf
Certificate Number: 201110640
134 Franklin Street, Albany, New York 12202
Effective: 08/31/2020 11/30/2020
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)
Eleanor R. Young Memorial Clinic
Service Type:
Program Name:
Certified Capacity:PRU 51423
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10640_820Riv.pdf
Certificate Number: 220111575
551 Bay Road, Queensbury, New York 12804
Effective: 02/01/2020 1/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52105
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11575_820Riv.pdf
Certificate Number: 200612187
13 Crandall Street, , Glens Falls, New York 12801
Effective: 07/22/2019 6/30/2020
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Crandall St. Reintegration
21Service Type:
Program Name:
Certified Capacity:PRU 53339
for men
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12187_820Riv.pdf
A.R.E.B.A. - Casriel, Inc. d/b/a Addiction Care Interventions
Ms. Hawa U. Jalloh LMSW, M-CASAC, CEO
589 Rockaway Avenue, Brooklyn, NY 11212
Provider Number: 11490
Administrative Office:
Telephone - (929)-258-0059 Ext 1002
Certificate Number: 211210643
8th Floor, 255 West 36th Street, , New York, New York 10018
Effective: 01/29/2021 12/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)
Alcoholism Treatment Center
Service Type:
Program Name:
Certified Capacity:PRU 3489
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10643_AREBAC.pdf
January 31, 2022 Page 1 of 227
Certificate Number: 221011439
Pharmacy - 1st Floor, Floors 1-4, 589 Rockaway Avenue, , Brooklyn, New York 11212
Effective: 11/01/2021 10/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 135Service Type:
Program Name:
Certified Capacity:PRU 51656
with Telepractice Designation (w/ability to swing 45 beds between Medically Supervised Inpatient Withdrawal and Inpatient Rehab. services with the use of methadone)
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11439_AREBAC.pdf
Certificate Number: 221011447
Floors 3-5, 589 Rockaway Avenue, , Brooklyn, New York 11212
Effective: 11/01/2021 10/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 46Service Type:
Program Name:
Certified Capacity:PRU 51389
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11447_AREBAC.pdf
AAA Health, Inc.
Ms. Alla Papush, Administrator
1090 Coney Island Ave., Brooklyn, NY 11230
Provider Number: 43710
Administrative Office:
Telephone - (718)-421-2101
Certificate Number: 221011468
2nd Floor, 1090 Coney Island Avenue, Brooklyn, New York 11230
Effective: 10/02/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51953
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11468_AAAHea.pdf
Acacia Network, Inc. as Sponsor El Regreso, Inc. as Operator
Mr. Raul Russi, Chief Executive Officer
141-143 South 3rd Street, Brooklyn, NY 11211
Provider Number: 1522
Administrative Office:
Telephone - (347)-649-3295
Certificate Number: 190210021
834 East 156th Street, Bronx, New York 10455
Effective: 03/12/2018 2/28/2019
Program Location:
Establishment Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 54Service Type:
Program Name:
Certified Capacity:PRU 6093
for men.
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10021_Acacia.pdf
Certificate Number: 190211487
141-143 South Third Street, Brooklyn, New York 11211
Effective: 03/12/2018 2/28/2019
Program Location:
Establishment Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 40Service Type:
Program Name:
Certified Capacity:PRU 51995
for women.
January 31, 2022 Page 2 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11487_Acacia.pdf
Certificate Number: 220211511
141-143 South 3rd Street, Brooklyn, New York 11211
Effective: 08/01/2021 2/28/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6321
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11511_Acacia.pdf
Acacia Network, Inc. as Sponsor Greenhope Services for Women, Inc. as Operator
Mr Raul Russi, CEO
6th Floor, 300 E. 175th Street, Bronx, NY 10457
Provider Number: 31030
Administrative Office:
Telephone - (347)-649-3036
Certificate Number: 240212196
Basement & Floors 1-8, 435-439 East 119th Street, , New York, New York 10035
Effective: 03/01/2021 2/29/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 72Service Type:
Program Name:
Certified Capacity:PRU 53353
and up to 14 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12196_Acacia.pdf
Acacia Network, Inc. as Sponsor, United Bronx Parents, Inc. as Operator
Mr. Raul Russi, Chief Executive Officer
966 Prospect Avenue, Bronx, NY 10459
Provider Number: 330
Administrative Office:
Telephone - (347)-649-3036
Certificate Number: 181210107
773 Prospect Avenue, Bronx, New York 10455
Effective: 06/19/2018 12/31/2018
Program Location:
Amendment Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Lorraine Montenegro Women and Children's Facility
38Service Type:
Program Name:
Certified Capacity:PRU 5750
and up to 51 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10107_Acacia.pdf
Certificate Number: 181210553
1st-4th Floors, 1006 East 151st Street, Bronx, New York 10455
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
La Casita III - The Mix
21Service Type:
Program Name:
Certified Capacity:PRU 7258
and up to 44 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10553_Acacia.pdf
Acacia Network, Inc. as Sponsor, Bronx Addiction Services Integrated Concepts System, Inc. as Operator
Mr. Raul Russi, Chief Executive Officer
6th floor, 300 East 175th Street, Bronx, NY 10457
Provider Number: 1857
Administrative Office:
Telephone - (347)-649-3036
January 31, 2022 Page 3 of 227
Certificate Number: 240112165
[Sleeping Purposes Only for 15 beds at], 4th & 5th Floors, [Services Provided at], 1068 Franklin Avenue, 1064 Franklin Avenue, Bronx, New York 10456
Effective: 02/01/2021 1/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Franklin House
130Service Type:
Program Name:
Certified Capacity:PRU 53297
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12165_Acacia.pdf
Acacia Network, Inc. as Sponsor, Queens Village Committee for Mental Health for Jamaica Community Adolesc
Mr. Raul Russi, President & CEO
300 East 175th Street, Bronx, NY 11434
Provider Number: 31340
Administrative Office:
Telephone - 347-649-3037
Certificate Number: 220210090
116-30 Sutphin Boulevard, Jamaica, New York 11434
Effective: 03/19/2021 2/28/2022
Program Location:
Establishment Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 192Service Type:
Program Name:
Certified Capacity:PRU 1256
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10090_Queens.pdf
Acacia Network, Inc. as Sponsor, The Puerto Rican Organization to Motivate, Enlighten and Serve Addicts, Inc.
Mr. Raul Russi, Chief Executive Officer
1776 Clay Avenue, Bronx, NY 10457
Provider Number: 166
Administrative Office:
Telephone - (347)-649-3037 Ext 3036
Certificate Number: 220910351
1st & 3rd Floors, 1776 Clay Avenue, , Bronx, New York 10457
Effective: 09/01/2021 9/30/2022
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Residential Opioid Treatment Program (822) 110Service Type:
Program Name:
Certified Capacity:PRU 1183
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10351_Acacia.pdf
Certificate Number: 241111618
2nd Floor, 1776 Clay Avenue, Bronx, New York 10457
Effective: 12/01/2021 11/30/2024
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 30Service Type:
Program Name:
Certified Capacity:PRU 52099
- with the use of methadone [up to 2 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11618_Acacia.pdf
Certificate Number: 240311627
2nd Floor, 1776 Clay Avenue, Bronx, New York 10457
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 23Service Type:
Program Name:
Certified Capacity:PRU 52108
[up to 2 of these beds may be used for the provision of Section 816.7 medically supervised inpatent withdrawal & stabilization services, as needed]
January 31, 2022 Page 4 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11627_Acacia.pdf
Certificate Number: 230411638
Administrative Site: Floors 1 & 2, Services: Floors 3, 4 & 5, 311 East 175th Street, Bronx, New York 10457
Effective: 05/01/2020 4/30/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Rehabilitation Services for Youth (817) 40Service Type:
Program Name:
Certified Capacity:PRU 2
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11638_Acacia.pdf
Certificate Number: 220311834
4th Floor, 175 Central Avenue, Albany, New York 12206
Effective: 09/01/2020 3/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52747
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11834_Acacia.pdf
Certificate Number: 231111848
1st & 2nd Floor, 254 Virginia Street, Buffalo, New York 14201
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52766
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11848_Acacia.pdf
Certificate Number: 210911852
1st & 2nd Floor, 254 Virginia Street, Buffalo, New York 14201
Effective: 11/18/2020 9/30/2021
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Opioid Treatment Program (822) 200Service Type:
Program Name:
Certified Capacity:PRU 52775
with Telepractice Designation
Capacity Lifted
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11852_Acacia.pdf
Certificate Number: 231211856
1st and 4th Floor, 175 Central Avenue, , Albany, New York 12206
Effective: 01/01/2021 12/31/2023
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Opioid Treatment Program (822)
Camino Nuevo
400Service Type:
Program Name:
Certified Capacity:PRU 52785
with Telepractice Designation
Capacity Lifted
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11856_Acacia.pdf
January 31, 2022 Page 5 of 227
Certificate Number: 240311914
1st - 4th Floors, 561 Court Street, , Brooklyn, New York 11231
Effective: 04/27/2021 3/31/2024
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Opioid Treatment Program (822) 850Service Type:
Program Name:
Certified Capacity:PRU 52884
with Telepractice Designation
Capacity Lifted
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11914_Acacia.pdf
Certificate Number: 200811936
1st - 4th Floors, 561 Court Street, Brooklyn, New York 11231
Effective: 07/03/2020 8/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52898
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11936_Acacia.pdf
Certificate Number: 231011964
754 East 151st Street, , Bronx, New York 10455
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Opioid Treatment Program (822)
Ramon Velez Recovery Center
800Service Type:
Program Name:
Certified Capacity:PRU 52934
with Telepractice Designation
Capacity Lifted
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11946_Acacia.pdf
Certificate Number: 211012043
1st Floor, 754 East 151st Street, Bronx, New York 10455
Effective: 12/03/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Ramon Velez Recovery Center Outpatient Program
Service Type:
Program Name:
Certified Capacity:PRU 53022
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12043_Acacia.pdf
January 31, 2022 Page 6 of 227
Certificate Number: 220812274
1st & 3rd Floors, 1776 Clay Avenue, , Bronx, New York 10457
Effective: 09/01/2021 8/31/2022
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 53582
with Telepractice Designation
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Opioid Treatment Program (822) 550Service Type:
Program Name:
Certified Capacity:PRU 53581
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220912290
303 Main Street, Dunkirk, New York 14048
Effective: 12/27/2021 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Safe Point Lighthouse
Service Type:
Program Name:
Certified Capacity:PRU 53599
with Telepractice Designation
Opioid Treatment Program (822) 400Service Type:
Program Name:
Certified Capacity:PRU 53598
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Access: Supports for Living Inc.
Mr. Ronald Colavito, Executive Director
15 Fortune Road West, Middletown, NY 10941
Provider Number: 40310
Administrative Office:
Telephone - (845)-673-7077
Certificate Number: 220112185
Offices: 132, 133, and 134, 16-24 Union Street, , Middletown, New York 10940
Effective: 06/15/2021 1/31/2022
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)
Access: Recovery
Service Type:
Program Name:
Certified Capacity:PRU 53326
with Telepractice Designation
Offices: 303, 304, and 308, 21-23 Grand Street, Newburgh, NY 12550
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12185_Access.pdf
Action for a Better Community, Incorporated
Mr. Jerome Underwood, President and CEO
400 West Avenue, Rochester, NY 14611
Provider Number: 37090
Administrative Office:
Telephone - (585)-325-5116
January 31, 2022 Page 7 of 227
Certificate Number: 210710645
Basement and 1st Floors, 33 Chestnut Street, Rochester, New York 14604
Effective: 07/01/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
New Directions
Service Type:
Program Name:
Certified Capacity:PRU 50519
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10645_Action.pdf
The Addiction Center of Broome County, Inc.
Ms. Carmela Pirich, Executive Director
Colonial Plaza, 2nd Floor, 30 West State Street, Binghamton, NY 13901
Provider Number: 36030
Administrative Office:
Telephone - (607)-723-7308 Ext 124
Certificate Number: 231211044
Colonial Plaza, 2nd Floor, 30 West State Street, Binghamton, New York 13901
Effective: 11/12/2021 12/31/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50396
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51980
with Telepractice Designation
Suite A, 103 Leilanis Lane, Norwich, NY 13815
Additional Location(s) At:
Children's Home of Wyoming Conference, 1182 Chenango Street, Binghamton, NY 13901
Additional Location(s) At:
306 Main Street, Endicott, NY 13760
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11044_Addict.pdf
Addictions Care Center of Albany, Inc.
Mr. Keith W. Stack, Executive Director
Administration Building, 90 McCarty Avenue, Albany, NY 12202
Provider Number: 35090
Administrative Office:
Telephone - (518)-465-5470 Ext 214
Certificate Number: 200610128
90 McCarty Avenue, , Albany, New York 12202
Effective: 01/01/2018 6/30/2020
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819)
Albany Citizens Council Supportive Living
38Service Type:
Program Name:
Certified Capacity:PRU 51256
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10128_Addict.pdf
Certificate Number: 230910605
1044 Broadway, Menands, New York 12204
Effective: 10/01/2020 9/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50113
with Telepractice Designation
January 31, 2022 Page 8 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10605_Addict.pdf
Certificate Number: 220212137
90 McCarty Avenue, , Albany, New York 12202
Effective: 06/16/2021 2/28/2022
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Treatment, Recovery, Education and Empowerment (T.R.E.E.) House for Women and Child
16Service Type:
Program Name:
Certified Capacity:PRU 53212
with Telepractice Designation for women and up to 4 beds for children
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12137_Addict.pdf
Certificate Number: 200912207
90 McCarty Avenue, , Albany, New York 12202
Effective: 10/14/2019 9/30/2020
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
McCarty Avenue Men's Stabilization/Rehabilitation
24Service Type:
Program Name:
Certified Capacity:PRU 53459
with Telepractice Designation [for men]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12207_Addict.pdf
Certificate Number: 201112210
79 Glenwood Avenue, , Queensbury, New York 12804
Effective: 02/03/2020 11/30/2020
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Glenwood House
16Service Type:
Program Name:
Certified Capacity:PRU 53545
with Telepractice Designation
and up to 2 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12210_Addict.pdf
Certificate Number: 220112255
111 McCarty Avenue, , Albany, New York 12202
Effective: 02/06/2021 1/31/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Vista House
14Service Type:
Program Name:
Certified Capacity:PRU 53540
for women and up to 6 beds for their children
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12255_Addict.pdf
Addicts Rehabilitation Center Fund, Inc.
Rev. Reginald Williams, President and CEO
1881 Park Avenue, New York, NY 10035
Provider Number: 19
Administrative Office:
Telephone - (646)-783-5331 Ext 217
Certificate Number: 181212079
1881 Park Avenue, New York, New York 10035
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Residential Services (820) 216Service Type:
Program Name:
Certified Capacity:PRU 53111
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
January 31, 2022 Page 9 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12079_Addict.pdf
Advanced Human Services, Inc.
Anna Rikhter M.D., President
112-15 72nd Road, Forest Hills, NY 11375
Provider Number: 42660
Administrative Office:
Telephone - (718)-261-3437
Certificate Number: 181211467
Suite LL1, Basement, 112-15 72nd Road, Forest Hills, New York 11375
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51859
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11467_Advanc.pdf
Certificate Number: 181211763
Basement, 112-15 72nd Road, Forest Hills, New York 11375
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 30Service Type:
Program Name:
Certified Capacity:PRU 52612
with Telepractice Designation [without the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11763_Advanc.pdf
AIDS Service Center of Lower Manhattan, Inc. d/b/a Alliance for Positive Change
Ms. Sharen I. Duke, President/Chief Executive Officer
64 West 35th Street, New York, NY 10001
Provider Number: 48900
Administrative Office:
Telephone - (212)-645-0875 Ext 304
Certificate Number: 231011858
Ground Floor, 2036 Amsterdam Avenue, , New York, New York 10032
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
CASA Washington Heights
Service Type:
Program Name:
Certified Capacity:PRU 52799
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11858_AIDSSe.pdf
Albany County Department of Mental Health
Stephen J. Giordano Ph.D., Director
175 Green Street, Albany, NY 12202
Provider Number: 70520
Administrative Office:
Telephone - (518)-447-4567
Certificate Number: 231110648
1st and 2nd Floors, 260 South Pearl Street, Albany, New York 12202
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)
Albany County Alcohol and Substance Abuse Clinic
Service Type:
Program Name:
Certified Capacity:PRU 1865
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10648_Albany.pdf
January 31, 2022 Page 10 of 227
Alcohol and Drug Council of Tompkins County, Inc.
Ms. Angela D. Sullivan, Executive Director
Suite 500, 201 East Green Street, Ithaca, NY 14850
Provider Number: 36070
Administrative Office:
Telephone - (607)-274-6288
Certificate Number: 220410653
Suite 500, 5th Floor, 201 East Green Street, Ithaca, New York 14850
Effective: 10/28/2020 4/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50615
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10653_Alcoho.pdf
Alcohol and Substance Abuse Council of Jefferson County, Inc. d/b/a Pivot
Mr. William W. Bowman, Executive Director
Suite 320, 167 Polk Street, Watertown, NY 13601
Provider Number: 36130
Administrative Office:
Telephone - (315)-788-4660
Certificate Number: 220311991
Administrative Site Only:, Suite 320, 167 Polk Street, Watertown, New York 13601
Effective: 04/01/2020 3/31/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90689
Ohio Elementary School, 1537 Ohio Street, Watertown, NY 13601
Other Service Site(s) At:
West Carthage Elementary School, 31568 Cole Road, Carthage, NY 13619
Other Service Site(s) At:
Carthage High School, Guidance Office, 36500 Route 26, Carthage, NY 13619
Other Service Site(s) At:
LaFargeville Central School, 20414 Sunrise Avenue, LaFargeville, NY 13656
Other Service Site(s) At:
Watertown High School, Level 3, Balcony Office, 1335 Washington Street, Watertown, NY 13601
Other Service Site(s) At:
North Elementary School, 171 East Hoard Street, Watertown, NY 13601
Other Service Site(s) At:
Alexandria Bay Central School District, 2nd Floor, Room 307, 34 Bolton Avenue, Alexandria Bay, NY 13607
Other Service Site(s) At:
Carthage Elementary School, Beaver Lane, Carthage, NY 13619
Other Service Site(s) At:
Case Middle School, 1st Floor, Guidance Office, 1237 Washington Street, Watertown, NY 13601
Other Service Site(s) At:
General Brown Junior-High School, Room 117, 17643 Cemetery Road, Dexter, NY 13634
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11991_Alcoho.pdf
The Alcohol and Substance Abuse Prevention Council of Saratoga County
Ms. Janine Stuchin, Executive Director
125 High Rock Avenue, Saratoga Springs, NY 12866
Provider Number: 35250
Administrative Office:
Telephone - (518)-581-1230 Ext 3611
January 31, 2022 Page 11 of 227
Certificate Number: 230211992
Administrative Site Only:, 125 High Rock Avenue, Saratoga Springs, New York 12866
Effective: 11/16/2021 2/28/2023
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90681
South Glens Falls High School, 1st Floor, Guidance Office, 42 Merritt Road, South Glens Falls, NY 12803
Other Service Site(s) At:
Ballston Spa High School, 1st Floor, Student Services, 220 Ballston Avenue, Ballston Spa, NY 12020
Other Service Site(s) At:
Galway Central High School, 1st Floor, Room 109, 5317 Sacandaga Road, Galway, NY 12074
Other Service Site(s) At:
Corinth Middle-High School, 1st Floor, Guidance Suites, 105 Oak Street, Corinth, NY 12822
Other Service Site(s) At:
Oliver W. Winch Middle School, 1st Floor, Guidance Office, 99 Hudson Street, South Glens Falls, NY 12803
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11992_TheAlc.pdf
Alcoholism and Substance Abuse Council of Schenectady County, Inc. d/b/a New Choices Recovery Center
Ms. Laura Combs, Executive Director
728 State Street, Schenectady, NY 12307
Provider Number: 35060
Administrative Office:
Telephone - (518)-348-7968
Certificate Number: 230210589
1st & 2nd Floors, 728 State Street, Schenectady, New York 12307
Effective: 03/01/2020 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50332
with Telepractice and Problem Gambling Designations
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51966
with Telepractice Designation
122 Park Avenue, Schenectady, NY 12304
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10589_Alcoho.pdf
Certificate Number: 231111825
840 State Street, , Schenectady, New York 12307
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52777
with Telepractice Designation with Problem Gambling Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11825_Alcoho.pdf
January 31, 2022 Page 12 of 227
Certificate Number: 220412259
406-408 Summit Avenue, , Schenectady, New York 12307
Effective: 05/03/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Purcell House
16Service Type:
Program Name:
Certified Capacity:PRU 53548
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220412260
575 Lansing Street, , Schenectady, New York 12303
Effective: 05/03/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Georgia S. Perrin House
21Service Type:
Program Name:
Certified Capacity:PRU 53547
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220412261
834 Emmett Street, , Schenectady, New York 12307
Effective: 05/03/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Margaret T. Smith House
21Service Type:
Program Name:
Certified Capacity:PRU 53549
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220412262
70 and 72 Union Avenue, , Schenectady, New York 12308
Effective: 05/03/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Bridge Center
22Service Type:
Program Name:
Certified Capacity:PRU 53546
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Allegany Council on Alcoholism and Substance Abuse, Inc.
Mr. William J. Penman, Executive Director
3084 Trapping Brook Road, Wellsville, NY 14895
Provider Number: 38110
Administrative Office:
Telephone - (585)-593-1920 Ext 722
Certificate Number: 191210170
3084 Trapping Brook Road, Wellsville, New York 14895
Effective: 01/02/2018 12/31/2019
Program Location:
Renewal Anticipated Recert Review:
Community Residential (819)
Trapping Brook House
17Service Type:
Program Name:
Certified Capacity:PRU 50178
Supportive Living (819)
Trapping Brook Supportive Living
10Service Type:
Program Name:
Certified Capacity:PRU 51068
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10170_Allega.pdf
January 31, 2022 Page 13 of 227
Certificate Number: 240410658
2956 Airway Road, Wellsville, New York 14895
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50177
with Telepractice Designation
40 West Main Street, Cuba, NY 14727
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10658_Allega.pdf
Amethyst House, Inc.
Ms. Angela A. DeSanno, Executive Director
280 Richmond Terrace, Staten Island, NY 10301
Provider Number: 31330
Administrative Office:
Telephone - (917)-816-1929
Certificate Number: 190110089
220 Heberton Avenue , , Staten Island, New York 10302
Effective: 01/01/2018 1/31/2019
Program Location:
Amendment Anticipated Recert Review:
Community Residential (819) 20Service Type:
Program Name:
Certified Capacity:PRU 51041
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10089_Amethy.pdf
Anchor House, Inc.
Ms. Alison King, Executive Director
APT, 1041-47 Bergen Street, Brooklyn, NY 11216
Provider Number: 610
Administrative Office:
Telephone - (718)-771-0760 Ext 101
Certificate Number: 220112128
976 Park Place, , Brooklyn, New York 11213
Effective: 02/01/2021 1/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Residential Services (820) 28Service Type:
Program Name:
Certified Capacity:PRU 53207
with Telepractice Designation (women)
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12128_Anchor.pdf
Certificate Number: 210712129
1041-1047 Bergen Street, , Brooklyn, New York 11216
Effective: 02/01/2021 7/31/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Residential Services (820) 50Service Type:
Program Name:
Certified Capacity:PRU 53208
(men) with Telepractice
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12129_Anchor.pdf
Argus Community, Inc.
Mr. Richard Weiss, President and Chief Executive Officer
Room 209, 2nd Floor, 760 East 160th Street, Bronx, NY 10456
Provider Number: 10160
Administrative Office:
Telephone - (917)-589-6322
January 31, 2022 Page 14 of 227
Certificate Number: 241210001
402 East 156th Street, Bronx, New York 10455
Effective: 01/01/2022 12/31/2024
Program Location:
Renewal Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Harbor House
59Service Type:
Program Name:
Certified Capacity:PRU 5960
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10001_ArgusC.pdf
Certificate Number: 181210002
3rd Floor, 760 East 160th Street, , Bronx, New York 10456
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 50Service Type:
Program Name:
Certified Capacity:PRU 4200
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10002_ArgusC.pdf
Certificate Number: 231011505
2nd Floor - Room #s 201, 202, 207, 221, 223, 225, 227, 229 & 232, 1st Floor - Room #108, 760 East 160th Street, Bronx, New York 10456
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
The Elizabeth L. Sturz Outpatient Center
Service Type:
Program Name:
Certified Capacity:PRU 227
with Telepractice Designation
Floor #s 1 and 2, 226 East 144th Street, Bronx, NY 10451
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11505_ArgusC.pdf
Certificate Number: 240211781
2038 Davidson Avenue, Bronx, New York 10453
Effective: 03/01/2021 2/29/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90867
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11781_ArgusC.pdf
Certificate Number: 210511782
507 West 145th Street, New York, New York 10031
Effective: 09/09/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52628
with Telepractice Designation
1st Floor, 2015 Madison Avenue, New York , NY 10035
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11782_ArgusC.pdf
Certificate Number: 181211783
Basement-5th Floor, 202-204 Edgecombe Avenue, New York, New York 10030
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Striver House
60Service Type:
Program Name:
Certified Capacity:PRU 52629
January 31, 2022 Page 15 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11783_ArgusC.pdf
Certificate Number: 181212113
114-40 Van Wyck Expressway, South Ozone Park, New York 11420
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Medically Monitored Withdrawal & Stabilization Services (816.9) 36Service Type:
Program Name:
Certified Capacity:PRU 53156
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12113_ArgusC.pdf
Certificate Number: 240112154
2nd, 3rd & 4th Floors, 2015-25 Madison Avenue, , New York, New York 10035
Effective: 02/01/2021 1/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Mary S. Taylor Homeless Outreach Residence
150Service Type:
Program Name:
Certified Capacity:PRU 53274
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12154_ArgusC.pdf
Argus Community, Inc. as Sponsor Create, Inc. as Operator
Mr. Richard Weiss, President/CEO
760 East 160th Street, Bronx, NY 10456
Provider Number: 296
Administrative Office:
Telephone - (718)-401-5700
Certificate Number: 210810743
1st & 2nd Floors, Basement, 73-75 Lenox Avenue, New York, New York 10026
Effective: 09/16/2020 8/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 658
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10743_Create.pdf
Certificate Number: 210812084
121-123 West 111th Street, New York, New York 10026
Effective: 09/16/2020 8/31/2021
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820) 32Service Type:
Program Name:
Certified Capacity:PRU 53116
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12084_ArgusC.pdf
Argus Community, Inc. as Sponsor, Counseling Service of E.D.N.Y., Inc. as Operator
Mr. Richard Weiss, President/CEO
760 East 160th Street , Bronx, NY 10456
Provider Number: 80
Administrative Office:
Telephone - (718)-401-5700
Certificate Number: 211010740
9th Floor, 175 Remsen Street, Brooklyn, New York 11201
Effective: 11/20/2020 10/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6285
with Telepractice Designation [with ancillary withdrawal services]
January 31, 2022 Page 16 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10740_Counse.pdf
Certificate Number: 211010741
Suite 300, 175 Fulton Avenue, , Hempstead, New York 11550
Effective: 11/20/2020 10/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 5726
with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10741_Counse.pdf
Certificate Number: 211011478
Kings County District Attorney's Office, 3rd Floor, 210 Joralemon Street, Brooklyn, New York 11201
Effective: 11/20/2020 10/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51993
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11478_Counse.pdf
Certificate Number: 211011601
Suite 501, 5th Floor, 163-18 Jamaica Avenue, Jamaica, New York 11432
Effective: 11/20/2020 10/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52083
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11601_Counse.pdf
Arms Acres, Inc.
Ms. Patrice Wallace-Moore, Chief Executive Officer
75 Seminary Hill Road, Carmel, NY 10512
Provider Number: 32412
Administrative Office:
Telephone - (845)-225-3400 Ext 6131
Certificate Number: 210810097
A, B, and E Wings, Basement & 1st Floor, 75 Seminary Hill Road, , Carmel, New York 10512
Effective: 02/23/2021 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Arms Acres Adult Unit
152Service Type:
Program Name:
Certified Capacity:PRU 50795
with Telepractice Designation [with the use of methadone] [Up to 39 of these beds may be used for the provision of Part 816.7 medically supervised inpatient withdrawal & stabilization service as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10097_ArmsAc.pdf
Certificate Number: 210810665
7th Floor, 80-02 Kew Gardens Road, Kew Gardens, New York 11415
Effective: 05/29/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7248
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10665_ArmsAc.pdf
January 31, 2022 Page 17 of 227
Certificate Number: 240510666
1st Floor, 21 Old Route 6, , Carmel, New York 10512
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Arms Acres Outpatient Program
Service Type:
Program Name:
Certified Capacity:PRU 51591
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10666_ArmsAc.pdf
Certificate Number: 210811488
1st Floor, F Wing, 75 Seminary Hill Road, Carmel, New York 10512
Effective: 02/23/2021 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 39Service Type:
Program Name:
Certified Capacity:PRU 50798
with Telepractice Designation [with the use of methadone] [Up to 39 of these beds may be used for the provision of Part 818 inpatient rehabilitation services as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11488_ArmsAc.pdf
Certificate Number: 240611619
1st Floor, 3584 Jerome Avenue, Bronx, New York 10467
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52100
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11619_ArmsAc.pdf
Certificate Number: 210912074
1st Floor, 21 Old Route 6, , Carmel, New York 10512
Effective: 10/16/2019 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Full Agonist Treatment Program (822)
Arms Acres Opioid Treatment Program
200Service Type:
Program Name:
Certified Capacity:PRU 53070
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12074_ArmsAc.pdf
Arnot Health, Inc. as Sponsor Arnot Ogden Medical Center as Operator
Mr. Jonathan Lawrence, President and CEO
600 Roe Avenue, Elmira, NY 14905
Provider Number: 82200
Administrative Office:
Telephone - (607)-737-4233
Certificate Number: 200412197
6th Floor, 555 St. Joseph's Boulevard, , Elmira, New York 14901
Effective: 05/30/2019 4/30/2020
Program Location:
Establishment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
New Dawn Southern Tier Addiction Rehabilitation Services (STARS)
20Service Type:
Program Name:
Certified Capacity:PRU 53357
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12197_ArnotH.pdf
January 31, 2022 Page 18 of 227
Backstretch Employee Service Team of New York, Inc.
Mr. Paul Ruchames LCSW, Executive Director
Belmont Park, Gate 6, Cottage 28B, 2150 Hempstead Turnpike, Elmont, NY 11003
Provider Number: 47560
Administrative Office:
Telephone - (516)-488-3434 Ext 103
Certificate Number: 200911723
Cottage 28B, Belmont Park, Gate 6, 2150 Hempstead Turnpike, Elmont, New York 11003
Effective: 01/01/2018 9/30/2020
Program Location:
Special ReIssue Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52547
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11723_Backst.pdf
Baden Street Settlement of Rochester, Inc.
Mr. Ron Thomas, Executive Director
152 Baden Street, Rochester, NY 14605
Provider Number: 16220
Administrative Office:
Telephone - (585)-445-6718
Certificate Number: 190910671
1st and 2nd Floor, 585 Joseph Avenue, Rochester, New York 14605
Effective: 01/01/2018 9/30/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 130
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10671_BadenS.pdf
Behavioral Enhancement and Substance Abuse Medicine Treatment, PLLC
Tomrul Tuzel M.D., CEO/Medical Director
Suite 17, 770 Grand Boulevard, Deer Park, NY 11729
Provider Number: 48360
Administrative Office:
Telephone - (631)-392-4357
Certificate Number: 220311797
Suite 17, 770 Grand Boulevard, , Deer Park, New York 11729
Effective: 05/05/2021 3/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52688
with Telepractice Designation
21 Technology Drive, East Setauket, NY 11733
Additional Location(s) At:
6-7 Middle Country Road, Middle Island, NY 11953
Additional Location(s) At:
33 Foster Avenue, Sayville, NY 11782
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11797_Behavi.pdf
Certificate Number: 220912277
998 Old Country Road, , Plainview, New York 11803
Effective: 11/23/2021 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
BEST-Plainview
Service Type:
Program Name:
Certified Capacity:PRU 53587
with Telepractice Designation
January 31, 2022 Page 19 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12277_Behavi
Behavioral Health Services North, Inc.
Mr. Mark A. Lukens, President/CEO
Suite 218, 22 U.S. Oval, Plattsburgh, NY 12903
Provider Number: 12050
Administrative Office:
Telephone - (518)-324-2177
Certificate Number: 211012236
25 Willowbrook Road, , Queensbury, New York 12804
Effective: 08/10/2021 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
The Center for Recovery
Service Type:
Program Name:
Certified Capacity:PRU 53508
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12236_Behavi.pdf
Certificate Number: 211012237
Basement & 1st Floor, 340 Main Street, , Hudson Falls, New York 12839
Effective: 08/10/2021 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
The Center for Recovery
Service Type:
Program Name:
Certified Capacity:PRU 53509
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12237_Behavi.pdf
Certificate Number: 211212251
1st and 2nd Floors, 75 Oak Street, , Plattsburgh, New York 12901
Effective: 01/08/2021 12/31/2021
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Twin Oaks
20Service Type:
Program Name:
Certified Capacity:PRU 53530
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12251_Behavi.pdf
BGR Services, Inc. d/b/a The PAC Program of Brooklyn
Ms. Maria Mendez, Executive VP/COO
7 Debevoise Street, Brooklyn, NY 11206
Provider Number: 44840
Administrative Office:
Telephone - (212)-837-2013
Certificate Number: 210811567
2nd Floor, 7 Debevoise Street, Brooklyn, New York 11206
Effective: 05/15/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52021
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11567_BGRSer.pdf
Bikur Cholim, Inc.
Mr. Aron Reiner, Executive Director
25 Robert Pitt Drive, Monsey, NY 10952
Provider Number: 20470
Administrative Office:
Telephone - (845)-425-7877 Ext 123
January 31, 2022 Page 20 of 227
Certificate Number: 240312018
Suite 101, 1st Floor, 25 Robert Pitt Drive, Monsey, New York 10952
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52968
[with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12018_BikurC.pdf
Bleuler Psychotherapy Center, Inc.
Steven Helfand Psy.D, Executive Director
3rd Floor, 104-70 Queens Boulevard, Forest Hills, NY 11375
Provider Number: 15300
Administrative Office:
Telephone - (718)-275-6010
Certificate Number: 210211700
3rd Floor, 104-70 Queens Boulevard, , Forest Hills, New York 11375
Effective: 09/01/2020 2/28/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)
Bleuler Chemical Dependency Recovery Services
Service Type:
Program Name:
Certified Capacity:PRU 52521
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11700_Bleule.pdf
Bliss-Poston The Second Wind, Inc.
Mr. John Bliss, Executive Director
Suite 403, 928 Broadway, New York, NY 10010
Provider Number: 1823
Administrative Office:
Telephone - (212)-481-1055
Certificate Number: 220110675
Suite 403, 4th Floor, 928 Broadway, New York, New York 10010
Effective: 08/31/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 5111
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10675_BlissP.pdf
BMMG Health Company LLC d/b/a Voyage Health
Mr. Brian McMahon, Executive Director
Suite 1B, 251 Oakland Avenue, Port Jefferson, NY 11777
Provider Number: 51670
Administrative Office:
Telephone - (631)-310-3418
Certificate Number: 221012291
Suite 1B, 251 Oakland Avenue, , Port Jefferson, New York 11777
Effective: 11/15/2021 10/31/2022
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)
Voyage Health
Service Type:
Program Name:
Certified Capacity:PRU 53543
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12291_BMMGHe.pdf
Bon Secours Community Hospital
Mary Leahy M.D., Chief Executive Officer
160 East Main Street, Port Jervis, NY 12771
Provider Number: 81780
Administrative Office:
Telephone - (845)-368-5000
January 31, 2022 Page 21 of 227
Certificate Number: 210910242
4th Floor, 160 East Main Street, Port Jervis, New York 12771
Effective: 12/05/2018 9/7/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6)
New Directions
7Service Type:
Program Name:
Certified Capacity:PRU 51051
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10242_BonSec.pdf
Certificate Number: 210911363
4th Floor, 160 East Main Street, Port Jervis, New York 12771
Effective: 12/05/2018 9/7/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
New Directions
15Service Type:
Program Name:
Certified Capacity:PRU 51824
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11363_BonSec.pdf
Bowery Residents' Committee, Inc.
Mr. Muzzy Rosenblatt, CEO/President
12th Floor, 131 West 25th Street, New York, NY 10001
Provider Number: 50490
Administrative Office:
Telephone - (212)-803-5700
Certificate Number: 221110622
Rooms 1005, 1009, 1010, 1011, 1012, 1016, 1017, 1018, Conf rooms 1, 2 & 3, 10th Floor, 127 West 25th Street, , New York, New York 10001
Effective: 07/31/2020 11/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50012
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10622_Bowery.pdf
Certificate Number: 230912117
127 West 25th Street, New York, New York 10001
Effective: 10/01/2021 9/30/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 32Service Type:
Program Name:
Certified Capacity:PRU 53160
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12117_Bowery.pdf
Boys and Girls Harbor, Inc.
Thomas Howard Ph.D., Executive Director
1 East 104th Street, New York, NY 10029
Provider Number: 31050
Administrative Office:
Telephone - (212)-427-2244 Ext 582
Certificate Number: 200211967
4th, 5th & 7th Floor, 1 East 104th Street, New York, New York 10029
Effective: 01/01/2018 2/29/2020
Program Location:
Special ReIssue Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90776
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11967_Boysan.pdf
January 31, 2022 Page 22 of 227
Bridge Back to Life Center, Inc.
Mr. Gary A. Butchen, Chief Executive Officer
Lower Level, 4271 Hempstead Turnpike, Bethpage, NY 11714
Provider Number: 2050
Administrative Office:
Telephone - (516)-520-6600
Certificate Number: 201110677
Basement, 1688 Victory Boulevard, Staten Island, New York 10314
Effective: 04/22/2020 11/30/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6094
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10677_Bridge.pdf
Certificate Number: 211110678
Basement, 4271 Hempstead Turnpike, Bethpage, New York 11714
Effective: 04/22/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7139
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10678_Bridge.pdf
Certificate Number: 210111254
3rd Floor, 3044 Coney Island Avenue, Brooklyn, New York 11235
Effective: 04/22/2020 1/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7356
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11254_Bridge.pdf
Certificate Number: 210111343
10th Floor, 175 Remsen Street, Brooklyn, New York 11201
Effective: 04/22/2020 1/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7180
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11343_Bridge.pdf
The Bridge, Inc.
Ms. Susan Wiviott, Chief Executive Officer
248 West 108th Street, New York, NY 10025
Provider Number: 18130
Administrative Office:
Telephone - (212)-663-3318
Certificate Number: 210511428
Cellar, 1st, 2nd, 3rd, 4th & 5th Floors, 248-250 West 108th Street, , New York , New York 10025
Effective: 10/07/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
The Center for Wellness and Change
Service Type:
Program Name:
Certified Capacity:PRU 7371
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11428_Bridge.pdf
January 31, 2022 Page 23 of 227
Bridging Access to Care, Inc.
Ms. Nadine Akinyemi, Executive Director
2261 Church Avenue, Brooklyn, NY 11226
Provider Number: 31640
Administrative Office:
Telephone - (347)-505-5115
Certificate Number: 220111255
2261 Church Avenue, Brooklyn, New York 11226
Effective: 05/28/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7275
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11255_Bridgi.pdf
BronxCare Health System
Mr. Miguel A. Fuentes Jr., President, Chief Executive Officer
Executive Suite, Main Floor, 1276 Fulton Avenue, Bronx, NY 10456
Provider Number: 85190
Administrative Office:
Telephone - (718)-901-8800
Certificate Number: 220310288
Life Recovery Center, 5th Floor, 1285 Fulton Avenue, Bronx, New York 10456
Effective: 04/01/2019 3/31/2022
Program Location:
Renewal Anticipated Recert Review:
Community Residential (819)
BronxCare Life Recovery Community Residence
22Service Type:
Program Name:
Certified Capacity:PRU 50036
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10288_BronxC.pdf
Certificate Number: 210310445
1276 Fulton Avenue, Bronx, New York 10456
Effective: 07/10/2020 3/31/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Opioid Treatment Program (822)
BronxCare Opioid Treatment Program
600Service Type:
Program Name:
Certified Capacity:PRU 309
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10445_BronxC.pdf
Certificate Number: 240511409
4th Floor, 1285 Fulton Avenue, Bronx, New York 10456
Effective: 05/21/2021 5/21/2024
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
BronxCare Addictions Rehabilitation Program
25Service Type:
Program Name:
Certified Capacity:PRU 51116
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11409_BronxC.pdf
Certificate Number: 220711845
1st and 2nd Floors, 1285 Fulton Avenue, Bronx, New York 10456
Effective: 08/01/2021 7/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:OASAS Host
Integrated Outpatient Services - PCService Type:
Program Name:
Certified Capacity:PRU
Outpatient Service (822)
BronxCare Chemical Dependence Outpatient Treatment Program
Service Type:
Program Name:
Certified Capacity:PRU 52764
with Telepractice Designation
January 31, 2022 Page 24 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11845_BronxC.pdf
Certificate Number: 240511846
Life Recovery Center, 3rd Floor, 1285 Fulton Avenue, Bronx, New York 10456
Effective: 05/21/2021 5/21/2024
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
BronxCare Addictions Detoxification Program
20Service Type:
Program Name:
Certified Capacity:PRU 52763
[Up to 10 of these beds (in Room #s 319, 321, 322, 324, 325, 327, 328, 330, 331, and 333) may be used for the provision of Part 818 inpatient rehabilitation services, as needed.]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11846_BronxC.pdf
Brookhaven Memorial Hospital Medical Center, Inc. d/b/a Long Island Community Hospital
Mr. Richard T. Margulis, President and Chief Executive Officer
101 Hospital Road, Patchogue, NY 11772
Provider Number: 85340
Administrative Office:
Telephone - (631)-654-7177
Certificate Number: 210810679
550 Montauk Highway, , Shirley, New York 11967
Effective: 09/29/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Memorial Hospital Medical Center Outpatient Chemical Dependency Services
Service Type:
Program Name:
Certified Capacity:PRU 50101
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10679_Brookh.pdf
Brooklyn Center for Psychotherapy, Inc.
Ms. Kerri Kopelowitz, Executive Director
300 Flatbush Avenue, Brooklyn, NY 11217
Provider Number: 32130
Administrative Office:
Telephone - 718-622-2000
Certificate Number: 230510680
500/500A /502A Atlantic Avenue, Brooklyn, New York 11217
Effective: 06/01/2021 5/31/2023
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)
New Directions
0Service Type:
Program Name:
Certified Capacity:PRU 50337
with Telepractice Designation
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10680_Brookl.pdf
The Brooklyn Hospital Center
Gary Terrinoni M.D., President and CEO
121 DeKalb Avenue, Brooklyn, NY 11201
Provider Number: 27480
Administrative Office:
Telephone - (718)-250-8005
January 31, 2022 Page 25 of 227
Certificate Number: 220710510
B Building, Downtown Campus, 9th Floor, 121 DeKalb Avenue, Brooklyn, New York 11201
Effective: 04/09/2020 7/31/2022
Program Location:
Amendment Anticipated Recert Review:
Medically Managed Withdrawal & Stabilization Services (816.6) 6Service Type:
Program Name:
Certified Capacity:PRU 8033
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10510_Brookl.pdf
Brooks-TLC Hospital System, Inc.
Ms. Mary E. LaRowe, President and CEO
529 Central Avenue, Dunkirk, NY 14048
Provider Number: 49960
Administrative Office:
Telephone - (716)-363-7207
Certificate Number: 210512141
33 North Main Street, Cassadaga, New York 14718
Effective: 06/10/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53215
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12141_Brooks.pdf
Certificate Number: 210412142
7020 Erie Road, Derby, New York 14047
Effective: 06/10/2020 4/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53229
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12142_Brooks.pdf
Brownsville Community Development Corporation
Mr. Harvey Lawrence, Chief Executive Officer/President
592 Rockaway Avenue, Brooklyn, NY 11212
Provider Number: 45250
Administrative Office:
Telephone - (718)-345-5000 Ext 1123
Certificate Number: 211211588
657-663 East 98th Street, Brooklyn, New York 11236
Effective: 01/01/2019 12/31/2021
Program Location:
Renewal Anticipated Recert Review:
Community Residential (819) 21Service Type:
Program Name:
Certified Capacity:PRU 51330
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11588_Browns.pdf
Brylin Hospitals, Inc.
Mr. Eric D. Pleskow, Chief Executive Officer
1263 Delaware Avenue, Buffalo, NY 14209
Provider Number: 81490
Administrative Office:
Telephone - (716)-886-8200 Ext 7601
January 31, 2022 Page 26 of 227
Certificate Number: 240310687
531 Farber Lakes Drive, Williamsville, New York 14221
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50709
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10687_Brylin.pdf
Buffalo Beacon Corporation d/b/a Beacon Center
Ms. Jacqueline West, Chief Executive Officer
3354 Sheridan Drive, Amherst, NY 14226
Provider Number: 32812
Administrative Office:
Telephone - (716)-602-9525
Certificate Number: 220910688
Suite 105, 295 Main Street, Buffalo, New York 14203
Effective: 01/03/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51708
with Telepractice Designtation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10688_Buffal.pdf
Certificate Number: 230910689
3354 Sheridan Drive, Amherst, New York 14226
Effective: 10/01/2020 9/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51048
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10689_Buffal.pdf
Certificate Number: 221210692
36 East Avenue, Lockport, New York 14094
Effective: 01/03/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51818
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10692_Buffal.pdf
Certificate Number: 230211256
Room 106, 417 3rd Street, Niagara Falls, New York 14301
Effective: 03/01/2020 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7330
With Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11256_Buffal.pdf
January 31, 2022 Page 27 of 227
Certificate Number: 240311631
1st and 2nd Floors, 210 South Main Street, Herkimer, New York 13350
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Beacon Center
Service Type:
Program Name:
Certified Capacity:PRU 52112
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11631_Buffal.pdf
Certificate Number: 210211754
1508 Genesee Street, Utica, New York 13502
Effective: 11/20/2020 2/28/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52584
with Telepractice Designation
303 West Liberty Street, Rome, NY 13440
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11754_Buffal.pdf
Certificate Number: 230912042
303 West Liberty Street, Rome, New York 13440
Effective: 10/01/2020 9/30/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 150Service Type:
Program Name:
Certified Capacity:PRU 53021
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12042_Buffal.pdf
Certificate Number: 240112140
201 King Street, Herkimer, New York 13350
Effective: 02/01/2021 1/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Albert O. Nichols House
15Service Type:
Program Name:
Certified Capacity:PRU 53239
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12140_Buffal.pdf
Certificate Number: 210612231
1st Floor, 1508 Genesee Street, , Utica, New York 13502
Effective: 09/04/2020 6/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 150Service Type:
Program Name:
Certified Capacity:PRU 53501
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12231_Buffal.pdf
C.C.M.S.
Mr. Emory X. Brooks, President and Chief Executive Officer
2nd Floor, 25 Elm Place, Brooklyn, NY 11201
Provider Number: 19430
Administrative Office:
Telephone - (718)-802-0666
January 31, 2022 Page 28 of 227
Certificate Number: 211110695
1st Floor, 810 Classon Avenue, , Brooklyn, New York 11238
Effective: 12/01/2019 11/30/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7277
2nd Floor, 25 Elm Place, Brooklyn, NY 11201
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10695_CCMS.pdf
CAMBA, Inc.
Ms. Joanne M. Oplustil, President and CEO
2nd Floor, 1720 Church Avenue, Brooklyn, NY 11226
Provider Number: 31600
Administrative Office:
Telephone - 718-287-2600
Certificate Number: 240411979
Administrative Site Only:, 2nd Floor, 1720 Church Avenue, Brooklyn, New York 11226
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90812
Public School 249, 2nd Floor, Room 202, 18 Marlborough Road, Brooklyn, NY 11226
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11979_CAMBAI.pdf
Camelot of Staten Island, Inc.
Mr. Luke J. Nasta, Executive Director
Suite 4, 4442 Arthur Kill Road, Staten Island, NY 10309
Provider Number: 12030
Administrative Office:
Telephone - (718)-356-5100
Certificate Number: 210810696
1268 Forest Avenue, Staten Island, New York 10302
Effective: 07/10/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 1687
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10696_Camelo.pdf
Certificate Number: 210410697
Basement, 175-15 Rockaway Boulevard, Jamaica, New York 11434
Effective: 07/10/2020 4/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 5594
with Telepractice Designation
1st, 3rd & 4th Floors, 946 East 211th Street, Bronx, NY 10469
Additional Location(s) At:
2nd Floor, 730 Kelly Street, Bronx, NY 10455
Additional Location(s) At:
Basement, 521 West 49th Street, New York, NY 10019
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10697_Camelo.pdf
January 31, 2022 Page 29 of 227
Certificate Number: 240812147
Seaview Hospital, 460H Brielle Avenue, Staten Island, New York 10314
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 45Service Type:
Program Name:
Certified Capacity:PRU 53213
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12147_Camelo.pdf
Certificate Number: 220612267
273 Heberton Avenue, , Staten Island, New York 10302
Effective: 07/01/2021 6/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820) 24Service Type:
Program Name:
Certified Capacity:PRU 53541
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12267_Camelo
Care Counseling Center, LLC
Mr. Faruk Khwaja, Executive Director
214 West 116th Street, New York, NY 10026
Provider Number: 48850
Administrative Office:
Telephone - (212)-602-1400
Certificate Number: 210811861
214-216 West 116th Street, New York, New York 10026
Effective: 07/01/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52795
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11861_CareCo.pdf
Carnegie Hill Institute, Inc.
Ms. Anna Marie Karkus, Executive Director
Apt. 1BC, 116 East 92nd Street, New York, NY 10128
Provider Number: 549
Administrative Office:
Telephone - (305)-772-2289
Certificate Number: 220510383
Basement & 1st Floor, 116 East 92nd Street, New York, New York 10128
Effective: 06/05/2020 5/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 200Service Type:
Program Name:
Certified Capacity:PRU 1472
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10383_Carneg.pdf
Certificate Number: 220311257
Basement & 1st Floor, 116 East 92nd Street, New York, New York 10128
Effective: 04/01/2019 3/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7335
January 31, 2022 Page 30 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11257_Carneg.pdf
CASA-Trinity, Inc.
Ms. Ann Domingos, CEO
4612 Millennium Drive, Geneseo, NY 14454
Provider Number: 37130
Administrative Office:
Telephone - (585)-991-5012
Certificate Number: 211010847
Wing B, 4612 Millennium Drive, Geneseo, New York 14454
Effective: 11/01/2019 10/31/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50184
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10847_CASA-T.pdf
Certificate Number: 211210848
45 Maple Street, Dansville, New York 14437
Effective: 01/01/2020 12/31/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
CASA-Trinity, Inc.
0Service Type:
Program Name:
Certified Capacity:PRU 50186
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10848_Counci.pdf
Certificate Number: 231111692
2nd Floor, 150 Lake Street, Elmira, New York 14901
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
d/b/a Trinity of Chemung County
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52231
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11692_CASATr.pdf
Certificate Number: 200112156
45 Maple Street, , Dansville, New York 14437
Effective: 01/02/2020 1/31/2020
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820) 26Service Type:
Program Name:
Certified Capacity:PRU 53307
with telepractice designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12156_CASATr.pdf
Certificate Number: 240512201
1st Floor, 86 River Street, , Hornell, New York 14843
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53387
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12201_CASA-T.pdf
January 31, 2022 Page 31 of 227
Certificate Number: 210212213
7309 Seneca Road, Hornell, New York 14843
Effective: 03/12/2020 2/28/2021
Program Location:
Establishment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 4Service Type:
Program Name:
Certified Capacity:PRU 53386
[up to 3 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12213_CASA-T.pdf
Certificate Number: 230612228
7309 Seneca Road, Hornell, New York 14843
Effective: 07/01/2021 6/30/2023
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 26Service Type:
Program Name:
Certified Capacity:PRU 53491
[up to 6 of these beds may be used for the provision of Part 816.7 medically supervised withdrawal and stabilization serivces, as needed
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12228_CASA-T.pdf
Catholic Charities Neighborhood Services, Inc.
Ms Patricia Bowles, Senior Vice President/Chief Program Officer
14th Floor, 191 Joralemon Street, Brooklyn, NY 11201
Provider Number: 40490
Administrative Office:
Telephone - (718)-722-6146
Certificate Number: 220210600
1st Floor, 1623 Flatbush Avenue, , Brooklyn, New York 11210
Effective: 10/25/2021 2/22/2022
Program Location:
Emergency Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51149
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10600_Cathol.pdf
Catholic Charities of Fulton and Montgomery Counties
Ms. Mary A. Carpenter, Executive Director
Suite 100, 55 East Main Street, Johnstown, NY 12095
Provider Number: 12340
Administrative Office:
Telephone - (518)-762-8313 Ext 226
Certificate Number: 230112003
Suite 100, 55 East Main Street, Johnstown, New York 12095
Effective: 02/01/2020 1/31/2023
Program Location:
Renewal Anticipated Recert Review:
Prevention Counseling
Catholic Charities of Fulton County
Service Type:
Program Name:
Certified Capacity:PRU 90645
Oppenheim Ephratah St. Johnsville Elementary School, 6486 State Highway 29, St. Johnsville, NY 13452
Other Service Site(s) At:
Edinburg Common School District, Prevention Counseling Office, 4 Johnson Road, Edinburg, NY 12134
Other Service Site(s) At:
Wheelerville Union Free School District, 2417 State Highway 10, Caroga Lake, NY 12032
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12003_Cathol.pdf
January 31, 2022 Page 32 of 227
Certificate Number: 221212005
Building 2, 1 Kimball Street, Amsterdam, New York 12010
Effective: 01/01/2020 12/31/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90659
East High School, North Wing, 25 School District Road, Canajoharie, NY 13317
Other Service Site(s) At:
Fonda Fultonville Elementary School, 112 Old Johnstown Road, Fonda, NY 12068
Other Service Site(s) At:
East Hill School, 25 School District Road, Canajoharie, NY 13317
Other Service Site(s) At:
Fort Plain Jr./Sr. High School, 1 West Street, Fort Plains, NY 13339
Other Service Site(s) At:
Fonda Fultonville Central School, Cemetery Road, Fonda, NY 12068
Other Service Site(s) At:
Fonda Fultonville Middle School, 112 Old Johnstown Road, Fonda, NY 12068
Other Service Site(s) At:
Fonda Fultonville High School, 112 Old Johnstown Road, Fonda, NY 12068
Other Service Site(s) At:
Oppenheim Ephratah St. Johnsville Jr/Sr High School, 44 Center Street, St. Johnsville, NY 13452
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12005_Cathol.pdf
Catholic Charities of Herkimer County
Ms. Maureen Petrie, Executive Director
61 West St, Ilion, NY 13357
Provider Number: 17000
Administrative Office:
Telephone - (315)-894-9917 Ext 222
Certificate Number: 241012002
Room 7, Basement Level, 61 West Street, Ilion, New York 13357
Effective: 11/01/2021 10/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90649
Dolgeville Central School, Office Adj. to Room 12, 38 Slawson Street, Dolgeville, NY 13329
Other Service Site(s) At:
Herkimer Central School District, 1st Floor, Office, 801 W. German Street, Herkimer, NY 13350
Other Service Site(s) At:
Herkimer BOCES, 352 Gros Blvd Street, Herkimer, NY 13350
Other Service Site(s) At:
Poland Central School, 1st Floor, Guidance Office, 74 Cold Brook Street, Poland, NY 13431
Other Service Site(s) At:
Mt. Markham Central School District , 500 Fairground Road , West Winfield, NY 13491
Other Service Site(s) At:
Town of Webb School, 2nd Floor Office, 3002 Main Street, Old Forge, NY 13420
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12002_Cathol.pdf
January 31, 2022 Page 33 of 227
Catholic Charities of Orange, Sullivan & Ulster
Ms. Shannon Kelly, Deputy CEO
27 Matthews Street, Goshen, NY 10924
Provider Number: 45020
Administrative Office:
Telephone - (845)-294-5124 Ext 1002
Certificate Number: 210311577
101 Carpenter Place, Monroe, New York 10950
Effective: 04/01/2019 3/31/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Monroe Clinic OP
Service Type:
Program Name:
Certified Capacity:PRU 52117
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11577_Cathol.pdf
Certificate Number: 210311578
305 North Street, Middletown, New York 10940
Effective: 08/19/2019 3/31/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Middletown Clinic OP
Service Type:
Program Name:
Certified Capacity:PRU 52116
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11578_Cathol.pdf
Certificate Number: 230411579
1st Floor, 27 Matthews Street, Goshen, New York 10924
Effective: 08/31/2021 4/30/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Goshen Clinic OP
Service Type:
Program Name:
Certified Capacity:PRU 52115
with Telepractice Designation
South Wing, 4 Harriman Drive, Goshen, NY 10924
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11579_Cathol.pdf
Certificate Number: 210311580
Ground Floor, 280 Broadway, , Newburgh, New York 12550
Effective: 04/01/2019 3/31/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Newburgh Clinic OP
Service Type:
Program Name:
Certified Capacity:PRU 52122
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11580_Cathol.pdf
Certificate Number: 211111688
1st Floor, 17-19 Sussex Street, Port Jervis, New York 12771
Effective: 08/31/2021 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Port Jervis Clinic OP
Service Type:
Program Name:
Certified Capacity:PRU 52217
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11688_Cathol.pdf
January 31, 2022 Page 34 of 227
Certificate Number: 230411720
8 Scofield Street, Walden, New York 12586
Effective: 08/31/2021 4/30/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Walden Clinic OP
Service Type:
Program Name:
Certified Capacity:PRU 52539
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11720_Cathol.pdf
Certificate Number: 210111866
396 Broadway, Monticello, New York 12701
Effective: 02/01/2020 1/31/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)
Monticello Clinic OP/Day Rehab OP-R
Service Type:
Program Name:
Certified Capacity:PRU 52808
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52812
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11866_Cathol.pdf
Certificate Number: 230311869
1st & 2nd Floors, 17 Hamilton Avenue, Monticello, New York 12701
Effective: 08/31/2021 3/31/2023
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
Monticello MSW IP
6Service Type:
Program Name:
Certified Capacity:PRU 52806
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11869_Cathol.pdf
Certificate Number: 220912288
1st & 2nd Floors , 17 Hamilton Avenue, , Monticello, New York 12701
Effective: 10/11/2021 9/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Monticello Stabilization
10Service Type:
Program Name:
Certified Capacity:PRU 53517
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220912289
1st & 2nd Floors, 17 Hamilton Avenue and 16 Jones Street, , Monticello, New York 12701
Effective: 10/11/2021 9/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Monticello Rehabilitation and Reintegration
37Service Type:
Program Name:
Certified Capacity:PRU 53518
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12289_Cathol.pdf
Catholic Charities of the Diocese of Rochester d/b/a Catholic Charities Steuben/Livingston
Tabitha J. Brewster Ph.D., Chief Executive Director
23 Liberty Street, Bath, NY 14810
Provider Number: 44050
Administrative Office:
Telephone - (607)-776-8085
January 31, 2022 Page 35 of 227
Certificate Number: 230212053
Administrative Site Only:, 23 Liberty Street, , Bath, New York 14810
Effective: 11/01/2021 2/28/2023
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU
Haverling Junior Senior High School, Room 170, 25 Ellas Avenue, Bath, NY 14810
Other Service Site(s) At:
Hammondsport High School, Room 128A, Main Street, Hammondsport, NY 14840
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12053_Cathol.pdf
Certificate Number: 240212188
Basement, 1st & 2nd Floors, 130 Rumsey Street, , Bath, New York 14810
Effective: 03/01/2021 2/29/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 18Service Type:
Program Name:
Certified Capacity:PRU 53344
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12188_Cathol.pdf
Certificate Number: 240312189
Administrative Site:, 23 Liberty Street, , Bath, New York 14810
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 18Service Type:
Program Name:
Certified Capacity:PRU 53343
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12189_Cathol.pdf
Catholic Charities of the Diocese of Rochester d/b/a Catholic Family Center
Ms. Marlene Bessette, President and Chief Executive Officer
Floor #s 1 - 7, 79 North Clinton Avenue, Rochester, NY 14604
Provider Number: 20250
Administrative Office:
Telephone - (585)-546-7220 Ext 7153
Certificate Number: 240810700
Floor #s 1 - 7, 79 North Clinton Avenue, Rochester, New York 14604
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 1191
with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51933
with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10700_Cathol.pdf
January 31, 2022 Page 36 of 227
Certificate Number: 181211673
1st & 2nd Flrs, Basement, 380 Barrington Street, Rochester, New York 14607
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Barrington Street Community Residence
11Service Type:
Program Name:
Certified Capacity:PRU 52207
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11673_Cathol.pdf
Certificate Number: 181211674
1st & 2nd Flrs, Basement, 184 Alexander Street, Rochester, New York 14607
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Alexander Street Community Residence
16Service Type:
Program Name:
Certified Capacity:PRU 52208
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11674_Cathol.pdf
Certificate Number: 181211675
3rd Floor, 79 North Clinton Avenue, Rochester, New York 14604
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819)
Restart Supportive Living Program
24Service Type:
Program Name:
Certified Capacity:PRU 52210
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11675_Cathol.pdf
Certificate Number: 190611676
24 Jones Avenue, , Rochester, New York 14608
Effective: 03/01/2019 6/30/2019
Program Location:
Amendment Anticipated Recert Review:
Community Residential (819)
Jones Avenue Community Residence
24Service Type:
Program Name:
Certified Capacity:PRU 52209
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11676_Cathol.pdf
Certificate Number: 201111995
Administrative Site Only:, 79 N. Clinton Avenue, Rochester, New York 14604
Effective: 12/01/2018 11/30/2020
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90651
Hilton High School, 400 East Avenue, Hilton, NY 14468
Other Service Site(s) At:
Edison Technical High School, 655 Colfax Street, Rochester, NY 14606
Other Service Site(s) At:
Children's School of Rochester, 1st Floor, Room #95, 595 Upper Falls Boulevard, Rochester, NY 14605
Other Service Site(s) At:
Merton Williams Middle School, 200 School Lane, Hilton, NY 14468
Other Service Site(s) At:
Bishop Kearney High School, 125 Kings Highway South, Rochester, NY 14617
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11995_Cathol.pdf
January 31, 2022 Page 37 of 227
Certificate Number: 181212060
997 St. Paul Street, Rochester, New York 14605
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Residential Services (820)
Liberty Manor
17Service Type:
Program Name:
Certified Capacity:PRU 53040
[2 of these beds may be used temporarily for adults] - with Telepractice Designation
and up to 5 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12060_Cathol.pdf
Certificate Number: 190812061
Basement, 1st & 2nd Floors, 55 Troup Street, Rochester, New York 14608
Effective: 01/24/2019 8/31/2019
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Freedom House
30Service Type:
Program Name:
Certified Capacity:PRU 53038
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12061_Cathol.pdf
Certificate Number: 211212062
(Counseling), 407 East Union Street, 110 South Clinton Street, Basement, 1st & 2nd Floors, (Residence), , Newark, New York 14513
Effective: 12/20/2021 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Hannick Hall
20Service Type:
Program Name:
Certified Capacity:PRU 53039
[2 of these beds may be used temporarily for adults] - with Telepractice Designation
and up to 7 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12062_Cathol.pdf
Catholic Charities of the Diocese of Rockville Centre
Ms. Laura A. Cassell, Chief Executive Officer/Executive Director
90 Cherry Lane, Hicksville, NY 11801
Provider Number: 20580
Administrative Office:
Telephone - (516)-733-7000
Certificate Number: 201010586
St. Rosalie's Church, Lower Level, 31 East Montauk Highway, , Hampton Bays, New York 11946
Effective: 09/21/2020 10/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Hampton Bays Outpatient Clince
Service Type:
Program Name:
Certified Capacity:PRU 50125
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10586_Cathol.pdf
Certificate Number: 240912049
30-C Carlough Road, Bohemia, New York 11716
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Talbot House
35Service Type:
Program Name:
Certified Capacity:PRU 53205
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
January 31, 2022 Page 38 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12049_Cathol.pdf
Catholic Charities of the Diocese of Syracuse
Ms. Marie Walsh, Executive Director
10 Kennedy Parkway, Cortland, NY 13045
Provider Number: 50760
Administrative Office:
Telephone - (607)-756-5992 Ext 202
Certificate Number: 190810208
29 Charles Street, Cortland, New York 13045
Effective: 05/17/2019 8/31/2019
Program Location:
Amendment Anticipated Recert Review:
Supportive Living (819)
Recovery Apartment Program
9Service Type:
Program Name:
Certified Capacity:PRU 51514
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10208_Cathol.pdf
Certificate Number: 181211655
29 Charles Street, Cortland, New York 13045
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Catholic Charities The Charles Street Residence
14Service Type:
Program Name:
Certified Capacity:PRU 51308
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11655_Cathol.pdf
Catholic Charities of the Roman Catholic Diocese of Syracuse, N.Y. d/b/a Catholic Charities of Utica/Rome
Mr. Jack Callaghan, Executive Director
Administrative Office, 1408 Genesee Street, Utica, NY 13502
Provider Number: 20560
Administrative Office:
Telephone - (315)-724-2158
Certificate Number: 181210056
1616 Genesee Street, Utica, New York 13502
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 16Service Type:
Program Name:
Certified Capacity:PRU 51784
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10056_Cathol.pdf
Certificate Number: 200710057
Basement, 1st & 2nd Flrs, 1505 Whitesboro Street, Utica, New York 13502
Effective: 01/01/2018 7/31/2020
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 16Service Type:
Program Name:
Certified Capacity:PRU 50681
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10057_Cathol.pdf
Catholic Health System, Inc. as Sponsor Mount St. Mary's Hospital of Niagara Falls as Operator
Mr. Charles Urlaub, Chief Executive Officer
Mount St. Mary's Hospital of Niagara Falls as Operator, 5300 Military Road, Lewiston, NY 14092
Provider Number: 81790
Administrative Office:
Telephone - (716)-298-2017
January 31, 2022 Page 39 of 227
Certificate Number: 210211890
3rd and 4th Floors, 5300 Military Road, Lewiston, New York 14092
Effective: 10/03/2018 2/23/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
Clearview Treatment Services
69Service Type:
Program Name:
Certified Capacity:PRU 52859
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11890_Cathol.pdf
Cazenovia Recovery Systems, Inc.
Ms. Suzanne Bissonette J.D., Chief Executive Officer
Suite 417, 2495 Main Street, Buffalo, NY 14214
Provider Number: 38170
Administrative Office:
Telephone - (716)-852-4331 Ext 203
Certificate Number: 181211860
Administrative Site Only:, 2671 Main Street, , Buffalo, New York 14214
Effective: 01/01/2018 12/31/2018
Program Location:
Amendment Anticipated Recert Review:
Supportive Living (819) 138Service Type:
Program Name:
Certified Capacity:PRU 50806
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11860_Cazeno.pdf
Certificate Number: 190511961
Administrative Site Only:, 1522 Main Street, , Niagara Falls, New York 14305
Effective: 01/08/2018 5/31/2019
Program Location:
Amendment Anticipated Recert Review:
Supportive Living (819) 15Service Type:
Program Name:
Certified Capacity:PRU 52932
and up to 3 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11961_Cazeno.pdf
Certificate Number: 240112050
1st & 2nd Floors, 486 North Legion Drive, , Buffalo, New York 14210
Effective: 02/01/2021 1/31/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Cazenovia Manor by Caz Recovery
23Service Type:
Program Name:
Certified Capacity:PRU 53077
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12050_Cazeno.pdf
Certificate Number: 181212051
5586 Niagara Street Extension, Lockport, New York 14094
Effective: 01/01/2018 12/31/2018
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Madonna House by Caz Recovery
16Service Type:
Program Name:
Certified Capacity:PRU 53076
with Telepractice Designation
and up to 12 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12051_Cazeno.pdf
January 31, 2022 Page 40 of 227
Certificate Number: 220912122
923 Sycamore Street, , Buffalo, New York 14212
Effective: 10/01/2021 9/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Unity House by Caz Recovery
24Service Type:
Program Name:
Certified Capacity:PRU 53574
[for men]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12122_Cazeno.pdf
Certificate Number: 240112124
1st Floor, 9126 Sandrock Road & 9136 Sandrock Road, , Eden, New York 14057
Effective: 02/01/2021 1/31/2024
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Turning Point House by Caz Recovery
21Service Type:
Program Name:
Certified Capacity:PRU 53246
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12124_Cazeno.pdf
Certificate Number: 220912282
200 Albany Street, , Buffalo, New York 14213
Effective: 10/01/2021 9/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Casa Di Vita by Caz Recovery
19Service Type:
Program Name:
Certified Capacity:PRU 53573
[for women]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12282_Cazeno.pdf
Certificate Number: 220912283
7397 Lake Road, , Appleton, New York 14008
Effective: 10/01/2021 9/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Somerset House by Caz Recovery
17Service Type:
Program Name:
Certified Capacity:PRU 53571
[for women]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12283_Cazeno.pdf
Certificate Number: 220912284
Basement, 1st, 2nd & 3rd Floors, 431 Memorial Parkway, , Niagara Falls, New York 14303
Effective: 10/01/2021 9/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Sundram Manor by Caz Recovery
17Service Type:
Program Name:
Certified Capacity:PRU 53572
[for men]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12284_Cazeno.pdf
Center for Community Alternatives, Inc.
Mr. David Condliffe, Executive Director
Suite 701, 25 Chapel Street, Brooklyn, NY 11201
Provider Number: 2136
Administrative Office:
Telephone - (315)-546-4365
January 31, 2022 Page 41 of 227
Certificate Number: 231210704
7th Floor, 25 Chapel Street, Brooklyn, New York 11201
Effective: 01/01/2021 12/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Crossroads
Service Type:
Program Name:
Certified Capacity:PRU 6520
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10704_Center.pdf
Center for Comprehensive Health Practice, Inc.
Ms. Ann M. Mendelsohn, Chief Executive Officer
12th Floor, 1900 2nd Avenue, New York, NY 10029
Provider Number: 10030
Administrative Office:
Telephone - (212)-360-7481
Certificate Number: 211110705
12th Floor, 1900 2nd Avenue, , New York, New York 10029
Effective: 06/26/2021 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7053
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10705_Center.pdf
Certificate Number: 210311670
12th Floor, 1900 2nd Avenue, , New York, New York 10029
Effective: 07/10/2020 3/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 444Service Type:
Program Name:
Certified Capacity:PRU 3553
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11670_Center.pdf
The Center for Rapid Recovery, Inc.
Renee D. Charles Ph.D., President & Chief Executive Officer
312 Greenwich Street, Hempstead, NY 11550
Provider Number: 26730
Administrative Office:
Telephone - (516)-292-6449
Certificate Number: 230711050
1st Floor, 312 Greenwich Street, Hempstead, New York 11550
Effective: 08/01/2021 7/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 7252
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11050_Center.pdf
The Center for Youth Services, Inc.
Elaine Spaull Ph.D., Executive Director
905 Monroe Avenue, Rochester, NY 14620
Provider Number: 37050
Administrative Office:
Telephone - (585)-473-2464
January 31, 2022 Page 42 of 227
Certificate Number: 220311987
1st Floor, 901-905 Monroe Avenue, Rochester, New York 14620
Effective: 04/01/2019 3/31/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90698
School of the Arts (SOTA), 3rd Floor, Room 432, 45 Prince Street, Rochester, NY 14607
Other Service Site(s) At:
James Monroe High School, 2nd Floor, Room 202, 164 Alexander Street, Rochester, NY 14607
Other Service Site(s) At:
Joseph C. Wilson Magnet High School Commencement Academy, 501 Genesee Street, Rochester, NY 14611
Other Service Site(s) At:
East High School, 1st Floor, Room B-130, 1801 East Main Street, Rochester, NY 14609
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11987_Center.pdf
Central Nassau Guidance and Counseling Services, Inc.
Mr. Jeffrey Friedman, Chief Executive Officer
950 South Oyster Bay Road, Hicksville, NY 11801
Provider Number: 50710
Administrative Office:
Telephone - (516)-822-6111
Certificate Number: 230910706
950 South Oyster Bay Road, Hicksville, New York 11801
Effective: 10/01/2020 9/30/2023
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 771
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10706_Centra.pdf
Central Park Recovery, LLC
Ms Nicole Intervallo, Chief Executive Officer
2176 Central Park Avenue, Yonkers, NY 10710
Provider Number: 51520
Administrative Office:
Telephone - (914)-619-5242
Certificate Number: 220612241
2176 Central Park Avenue, , Yonkers, New York 10710
Effective: 07/19/2021 6/30/2022
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53514
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53564
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Champlain Valley Family Center for Drug Treatment and Youth Services, Inc.
Ms. Constance Wille, Chief Executive Director
20 Ampersand Drive, Plattsburgh, NY 12901
Provider Number: 1065
Administrative Office:
Telephone - (518)-561-8480
January 31, 2022 Page 43 of 227
Certificate Number: 220110710
20 Ampersand Drive, Plattsburgh, New York 12901
Effective: 05/11/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 3101
with Telepractice Designation
Hawkins Hall, Plattsburgh State University, Basement, Room 053E, 55 Beekman Street, Plattsburgh, NY 12901
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10710_Champl.pdf
Certificate Number: 240712015
20 Ampersand Drive, Plattsburgh, New York 12901
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90620
Beekmantown Central School District, Counseling Offices, 1st & 2nd Floors, 37 Eagle Way, West Chazy, NY 12992
Other Service Site(s) At:
AuSable Valley Central Middle School, Main Floor, Guidance Office - Rm 132, 1273 Route 9N, Keeseville, NY 12924
Other Service Site(s) At:
Peru Center Jr/Sr High School, Room 1C, 17 School Street, 1st Floor, Peru, NY 12972
Other Service Site(s) At:
Plattsburgh Middle School, Study, B-1, 15 Broad Street, Plattsburgh, NY 12901
Other Service Site(s) At:
Northern Adirondack Central School District, Room BC-2, 5586 State Route 11, Ellenburg Depot, NY 12935
Other Service Site(s) At:
Saranac Central School, 60 Picketts Corners Road, Saranac, NY 12981
Other Service Site(s) At:
Northeastern Clinton Middle/High School, High School, 1st Floor, Guidance Office, 103 Route 276, Champlain, NY 12919
Other Service Site(s) At:
Plattsburgh High School, Health Office, Room 406, One Clifford Drive, Plattsburgh, NY 12901
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12015_Champl.pdf
Certificate Number: 240412138
516 Norrisville Road , Schuyler Falls, New York 12985
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Champlain Valley Family Center Recovery Campus
16Service Type:
Program Name:
Certified Capacity:PRU 53247
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12138_Champl.pdf
Charles Evans Center, Inc.
Mr. James R. Dolan Jr., Executive Director
857 South Oyster Bay Road, Bethpage, NY 11714
Provider Number: 49140
Administrative Office:
Telephone - (516)-622-8888 Ext 225
January 31, 2022 Page 44 of 227
Certificate Number: 201112218
113 Glen Cove Avenue, , Glen Cove, New York 11542
Effective: 10/20/2020 11/30/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Charles Evans Center at Glen Cove
Service Type:
Program Name:
Certified Capacity:PRU 53342
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12218_Charle.pdf
Chautauqua County Department of Mental Health
Carmelo Hernandez M.S., M.B.A., Director of Community Mental Hygiene Services
Hall R Clothier Bldg., 1st Floor, 2 Academy Street, Mayville, NY 14757
Provider Number: 70360
Administrative Office:
Telephone - (716)-753-4104
Certificate Number: 240710711
City Hall, 5th Floor, 200 East Third Street, Jamestown, New York 14701
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50702
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10711_Chauta.pdf
Certificate Number: 240710712
2nd Floor, 319 Central Avenue, Dunkirk, New York 14048
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50703
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10712_Chauta.pdf
Chenango County Community Services Board
Ms. Ruth Roberts, Director
County Office Building, Suite 42, 5 Court Street, Norwich, NY 13815
Provider Number: 70010
Administrative Office:
Telephone - (607)-337-1604
Certificate Number: 231010713
Suite 42, 5 Court Street, Norwich, New York 13815
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Chenango County Behavioral Health Services
Service Type:
Program Name:
Certified Capacity:PRU 472
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10713_Chenan.pdf
Child & Family Guidance Center Addiction Services, Inc.
Mr. Christopher Dennehy, Executive Director
106 Vineyard Avenue, Highland, NY 12528
Provider Number: 16230
Administrative Office:
Telephone - (845)-594-4239
January 31, 2022 Page 45 of 227
Certificate Number: 221010715
106 Vineyard Avenue and 102 Vineyard Avenue (1st & 2nd Floors), Highland, New York 12528
Effective: 12/02/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51463
with Telepractice Designation
Step One, 500 Aaron Court, Kingston, NY 12401
Additional Location(s) At:
1st and 2nd Floors, 83 North Main Street, Ellenville, NY 12428
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10715_ChildF.pdf
Certificate Number: 221011653
Northeast Center for Rehab and Traumatic Brain Injury, 1st Floor, Rooms 322 & 507, 300 Grant Avenue, 2nd Floor, Rooms 128, 219, 333, & 704, Lake Katrine, New York 12449
Effective: 11/01/2019 10/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52156
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11653_ChildF.pdf
The Child Center of NY, Inc.
Ms. Traci Donnelly, CEO and Executive Director
6th Floor, 118-35 Queens Boulevard, Forest Hills, NY 11375
Provider Number: 18000
Administrative Office:
Telephone - (718)-651-7770
Certificate Number: 220510953
2nd Floor, 163-18 Jamaica Avenue, , Jamaica, New York 11432
Effective: 01/12/2022 5/31/2022
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)
Jamaica Family Center-CD-OP
Service Type:
Program Name:
Certified Capacity:PRU 6308
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10953_ChildC.pdf
Certificate Number: 220511277
140-15B Sanford Avenue, Flushing, New York 11355
Effective: 06/01/2019 5/31/2022
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51686
81-14 Queens Boulevard, Elmhurst, NY 11373
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11277_ChildC.pdf
The Children's Aid Society
Ms. Phoebe C. Boyer, President and CEO
117 W 124th Street, New York, NY 10027
Provider Number: 20660
Administrative Office:
Telephone - (212)-949-4800
January 31, 2022 Page 46 of 227
Certificate Number: 201111973
Basement & 1st Floor, New York, New York 10026-1904, 14-32 West 118th Street, Prevention Records at:, 117 West 124th Street, New York, New York 10027
Effective: 04/22/2020 11/30/2020
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90763
Opportunity Charter School, 4th Floor, 240 West 113th Street, New York, NY 10026
Other Service Site(s) At:
Lexington Academy PS 72, 408B, 131 East 104th Street, New York, NY 10029
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11973_TheChi.pdf
The Children's Village, Inc.
Jeremy Kohomban Ph.D., President/CEO
One Echo Hill, Dobbs Ferry, NY 10522
Provider Number: 14690
Administrative Office:
Telephone - (914)-693-0600 Ext 1201
Certificate Number: 230412143
1 Echo Hills, , Dobbs Ferry, New York 10522
Effective: 05/01/2021 4/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53242
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12143_Childr.pdf
Citizen Advocates, Inc. d/b/a North Star Industries
Mr. James Button, CEO
125 Finney Boulevard, P.O. Box 608, Malone, NY 12953
Provider Number: 40410
Administrative Office:
Telephone - (518)-483-1251
Certificate Number: 211010717
31 Sixth Street, Malone, New York 12953
Effective: 07/01/2018 10/31/2021
Program Location:
Amendment/Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 5048
[with ancillary withdrawal services]
7 Stetson Road, Tupper Lake, NY 12986
Additional Location(s) At:
143 White Birch Road, Indian Lake, NY 12842
Additional Location(s) At:
Lake Pleasant Central School - Lane Emporium, NYS Route 30 at Elm Lake Road, Speculator, NY 12164
Additional Location(s) At:
1st Floor, 70 Edgewood Road, Saranac Lake, NY 12983
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10717_Citize.pdf
January 31, 2022 Page 47 of 227
Certificate Number: 210312004
31 Sixth Street, Malone, New York 12953
Effective: 04/01/2019 3/31/2021
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90719
St. Regis Falls Central School, Room B121A, 92 North Main Street, St. Regis Falls, NY 12980
Other Service Site(s) At:
Malone High School (Franklin Academy), Room 118, 42 Huskie Lane, Malone, NY 12953
Other Service Site(s) At:
43 River Street, Chateaugay, NY 12920
Other Service Site(s) At:
Tupper Lake Central School, Rooms A207 & B107, 25 Chaney Avenue, Tupper Lake, NY 12986
Other Service Site(s) At:
Malone Middle School, Room 419, 15 Francis Street, Malone, NY 12953
Other Service Site(s) At:
Brushton-Moira Central School, Rooms D-10 & D-24, 758 County Route 7, Brushton, NY 12916
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12004_Citize.pdf
City of White Plains Youth Bureau
Mr. Frank Williams Jr., Executive Director
11 Amherst Place, White Plains, NY 10601
Provider Number: 29210
Administrative Office:
Telephone - (914)-422-1378 Ext 6702
Certificate Number: 240912027
11 Amherst Place, White Plains, New York 10601
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90664
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12027_Cityof.pdf
The Clifton Springs Sanitarium Company d/b/a Clifton Springs Hospital & Clinic
Dustin Riccio, President, Eastern Region
2 Coulter Road, Clifton Springs, NY 14432
Provider Number: 85490
Administrative Office:
Telephone - (315)-332-2298
Certificate Number: 230211879
Woodbury Building, 3rd Floor, 2 Coulter Road, Clifton Springs, New York 14432
Effective: 03/01/2021 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
The Inpatient Addiction Recovery Program
30Service Type:
Program Name:
Certified Capacity:PRU 52847
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11879_Clifto.pdf
January 31, 2022 Page 48 of 227
Certificate Number: 211211880
1st Floor, 2 Coulter Road, , Clifton Springs, New York 14432
Effective: 09/10/2020 12/31/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52846
with Telepractice Designation
1st Floor, 35 North Street, Canandaigua, NY 14424
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11880_Clifto.pdf
Clinton County Community Services Board
Ms. Richelle Gregory, Director of Community Services
Suite 1500, 130 Arizona Avenue, Plattsburgh, NY 12903
Provider Number: 70020
Administrative Office:
Telephone - (518)-565-4060
Certificate Number: 211110723
130 Arizona Avenue, Plattsburgh, New York 12903
Effective: 10/13/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)
Clinton County Addiction Services
Service Type:
Program Name:
Certified Capacity:PRU 50757
Building #2, 483 State Route 11, Champlain, NY 12919
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10723_Clinto.pdf
The Community Action Organization of Western New York, Inc.
Mr. L. Nathan Hare, CEO/President
Suite 150, 45 Jewett Avenue, Buffalo, NY 14214
Provider Number: 46
Administrative Office:
Telephone - (716)-881-5150
Certificate Number: 220410379
1st Floor, 1237 Main Street, Buffalo, New York 14209
Effective: 05/01/2020 4/30/2022
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822)
Drug Abuse Research and Treatment (DART) Program
430Service Type:
Program Name:
Certified Capacity:PRU 13
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10379_Commun.pdf
The Community Place of Greater Rochester, Inc.
Mr. Scott Benjamin, Chief Executive Officer
57 Central Park, Rochester, NY 14605
Provider Number: 42880
Administrative Office:
Telephone - 585-327-7200 Ext 112
Certificate Number: 240511803
Level 1 & Level Intermediate, 145 Parsells Avenue, Rochester, New York 14609
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90849
NE and NW HighSchool at the Frederick Douglas Campus, 940 Fernwood Park, Rochester, NY 14609
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11803_Commun.pdf
January 31, 2022 Page 49 of 227
Concern for Independent Living, Inc.
Mr. Ralph Fasano, Executive Director
312 Expressway Drive South, Medford, NY 11763
Provider Number: 16390
Administrative Office:
Telephone - (631)-758-0474
Certificate Number: 191011769
72 Riviera Drive, Selden, New York 11784
Effective: 01/01/2018 10/31/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819) 3Service Type:
Program Name:
Certified Capacity:PRU 52590
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11769_Concer.pdf
Concourse Medical Center, Inc.
Ms. Ana Matos, Acting Executive Director
880 Morris Avenue, Bronx, NY 10451
Provider Number: 43050
Administrative Office:
Telephone - (718)-665-9340 Ext 118
Certificate Number: 210911295
880 Morris Avenue, , Bronx, New York 10451
Effective: 10/01/2020 9/30/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Opioid Treatment Program (822) 600Service Type:
Program Name:
Certified Capacity:PRU 829
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11295_Concou.pdf
Confidential Help for Alcohol and Drugs, Inc.
Mr. Kevin D. Hares, Executive Director
75 Genesee Street, Auburn, NY 13021
Provider Number: 36200
Administrative Office:
Telephone - (315)-253-9786
Certificate Number: 231110727
The Piccolo Building, 1st Floor, 75 Genesee Street, , Auburn, New York 13021
Effective: 06/11/2021 10/31/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
CHAD
Service Type:
Program Name:
Certified Capacity:PRU 50846
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10727_Confid.pdf
Certificate Number: 230112019
The Piccolo Building, 1st Floor, 75 Genesee Street, , Auburn, New York 13021
Effective: 02/01/2020 1/31/2023
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90690
Millard Fillmore Elementary School, South Main Street, Moravia, NY 13118
Other Service Site(s) At:
Southern Cayuga Central School, 2384 Route 34B, Aurora, NY 13026
Other Service Site(s) At:
Moravia Central School, South Main Street, Moravia, NY 13118
Other Service Site(s) At:
January 31, 2022 Page 50 of 227
Union Springs Central School, 27 North Cayuga Street, Union Springs, NY 13160
Other Service Site(s) At:
Weedsport Central School, 2821 East Brutus Street, Weedsport, NY 13166
Other Service Site(s) At:
Cato-Meridian Central School, 2851 State Route 370, Cato, NY 13033
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12019_Confid.pdf
Conifer Park, Inc.
Ms. Patricia A. Wilcox, CEO
79 Glenridge Road, Glenville, NY 12302
Provider Number: 14770
Administrative Office:
Telephone - (518)-952-8323
Certificate Number: 201010018
A1, A2, B2, C2, D1, D2, D3 & S2, 79 Glenridge Road, Glenville, New York 12302
Effective: 10/22/2021 2/19/2022
Program Location:
Emergency Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 171Service Type:
Program Name:
Certified Capacity:PRU 50849
with Telepractice Designation [with the use of methadone] [using up to 28 beds for swing beds to Section 816.7 medically supervised inpatient withdrawal & stabilization service in A1 Rooms only]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10018_Conife.pdf
Certificate Number: 210810729
Basement,, 1st Floor and 2nd Floor, 55 Elm Street, , Glens Falls, New York 12801
Effective: 10/16/2019 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Conifer Park Outpatient Clinic
Service Type:
Program Name:
Certified Capacity:PRU 51101
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10729_Conife.pdf
Certificate Number: 210810730
2nd Floor, 600 Franklin Street, , Schenectady, New York 12305
Effective: 10/16/2019 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Outpatient Clinic
0Service Type:
Program Name:
Certified Capacity:PRU 51828
with Telepractice Designation [with ancillary withdrawal services at the additional location site at 79 Glenridge Road, Glenville only]
Cottage #1, 79 Glenridge Road, Glenville, NY 12302
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10730_Conife.pdf
Certificate Number: 210810731
550-556 South Clinton Avenue, , Rochester, New York 14620
Effective: 10/16/2019 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Outpatient Clinic
0Service Type:
Program Name:
Certified Capacity:PRU 5265
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10731_Conife.pdf
January 31, 2022 Page 51 of 227
Certificate Number: 211110732
Unit 1, 80 Sharron Avenue, , Plattsburgh, New York 12901
Effective: 10/16/2019 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51575
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10732_Conife.pdf
Certificate Number: 211210733
Building 2, Left Wing, Suite #s 4, 5 and 6, 526 Old Liverpool Road, Liverpool, New York 13088
Effective: 10/16/2019 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Victoria Square
Service Type:
Program Name:
Certified Capacity:PRU 51568
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10733_Conife.pdf
Certificate Number: 210510738
1st - 3rd Floors, 2435 Sixth Avenue, Troy, New York 12180
Effective: 10/16/2019 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51826
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10738_Conife.pdf
Certificate Number: 240711437
C1, 79 Glenridge Road, Glenville, New York 12302
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 34Service Type:
Program Name:
Certified Capacity:PRU 3814
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11437_Conife.pdf
Certificate Number: 211011809
Unit 1, 80 Sharron Avenue, , Plattsburgh, New York 12901
Effective: 10/16/2019 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Full Agonist Treatment Program (822) 100Service Type:
Program Name:
Certified Capacity:PRU 52696
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11809_Conife.pdf
Certificate Number: 211211944
Suite #s 4, 5 and 6, 526 Old Liverpool Road, , Liverpool, New York 13088
Effective: 05/01/2020 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Full Agonist Treatment Program (822) 200Service Type:
Program Name:
Certified Capacity:PRU 52959
with Telepractice Designation
Capacity Lifted
January 31, 2022 Page 52 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11944_Conife.pdf
Certificate Number: 210812065
1st, 2nd & 3rd Floors, 2435 Sixth Avenue, , Troy, New York 12180
Effective: 10/16/2019 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Full Agonist Treatment Program (822) 75Service Type:
Program Name:
Certified Capacity:PRU 53060
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12065_Conife.pdf
Certificate Number: 220112135
Part 822 - OTP, 2nd Floor, 600 Franklin Street, , Schenectady, New York 12305
Effective: 08/18/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 200Service Type:
Program Name:
Certified Capacity:PRU 53233
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12135_Conife.pdf
Contact Community Services, Inc.
Ms. Patricia R. Leone, Executive Director
6311 Court Street Road, East Syracuse, NY 13057
Provider Number: 12480
Administrative Office:
Telephone - (315)-251-1400 Ext 117
Certificate Number: 220411756
Administrative Site Only:, 6311 Court Street Road, East Syracuse, New York 13057
Effective: 05/01/2019 4/30/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90646
Institute of Technology at Syracuse Central, 258 E. Adams Street, Syracuse, NY 13202
Other Service Site(s) At:
Corcoran High School, 919 Glenwood Avenue, Syracuse, NY 13207
Other Service Site(s) At:
Cicero-North Syracuse High School, 6002 Route 31, Cicero, NY 13039
Other Service Site(s) At:
Nottingham High School, 3100 E. Genesee Street, Syracuse, NY 13224
Other Service Site(s) At:
PSLA @ Fowler, 227 Magnolia Street, Syracuse, NY 13204
Other Service Site(s) At:
Henninger High School, 600 Robinson Street, Syracuse, NY 13206
Other Service Site(s) At:
North Syracuse Junior High School, 5353 Taft Road, North Syracuse, NY 13212
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11756_Contac.pdf
COPAY, INC.
Ms. Maria E. Cuadra, Executive Director/CEO
2nd Floor, 21 North Station Plaza, Great Neck, NY 11021
Provider Number: 145
Administrative Office:
Telephone - (516)-466-2509
January 31, 2022 Page 53 of 227
Certificate Number: 210310739
2nd Floor, 21 North Station Plaza, Great Neck, New York 11021
Effective: 05/29/2020 3/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 497
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10739_COPAYI.pdf
Cornerstone Family Healthcare
Ms. Linda Muller, President and CEO
Suite 10, 2570 US Highway 9W, Cornwall, NY 12518
Provider Number: 45040
Administrative Office:
Telephone - (845)-220-3112
Certificate Number: 240611595
1st Floor, 3 Commercial Place, , Newburgh, New York 12550
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Center For Recovery
Service Type:
Program Name:
Certified Capacity:PRU 52069
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52071
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11595_Corner.pdf
Certificate Number: 240311642
1st Floor, 3 Commercial Place, , Newburgh, New York 12550
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822)
Center for Recovery Methadone Maintenance Treatment Program
450Service Type:
Program Name:
Certified Capacity:PRU 52138
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11642_Greate.pdf
Council on Addiction Prevention and Education of Dutchess County, Inc.
Ms. Regina Hernandez, Agency Site Director
Room 28, 807 Route 52, Fishkill, NY 12524
Provider Number: 34340
Administrative Office:
Telephone - (845)-745-6426
Certificate Number: 240111592
Room 28, 807 Route 52, Fishkill, New York 12524
Effective: 04/16/2021 1/31/2024
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90674
with Telepractice Designation
Wappingers Central School District - John Jay High School, 2012 Route 52, Hopewell Junction, NY 12533
Other Service Site(s) At:
Wappingers Central School District - Roy C. Ketchum High School, 99 Meyers Corners Road, Wappingers Falls, NY 12590
Other Service Site(s) At:
Hyde Park Central Schools - FDR High School, 154 South Cross Road, Hyde Park, NY 12538
Other Service Site(s) At:
January 31, 2022 Page 54 of 227
Dover Union Free School District - Dover Jr. - Sr. High School, 2368 Route 22, Dover Plains, NY 12522
Other Service Site(s) At:
Red Hook High School, 103 West Market Street, Red Hook, NY 12571
Other Service Site(s) At:
Wappingers Central School District - Wappingers Jr. High School, 30 Major MacDonald Way, Wappingers Falls, NY 12590
Other Service Site(s) At:
Wappingers Central School District - Van Wyck Jr., 10 Hillside Lake Road, Wappinger Falls, NY 12590
Other Service Site(s) At:
Linden Avenue Middle School, 66 West Market Street, Red Hook, NY 12501
Other Service Site(s) At:
Haviland Middle School, 23 Haviland Road, Hyde Park, NY 12538
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11592_Counci.pdf
Council on Addiction Recovery Services, Inc.
Mr. Michael Prutsman, Executive Director
201 South Union Street, P.O. Box 567, Olean, NY 14760
Provider Number: 38160
Administrative Office:
Telephone - (716)-373-4303 Ext 513
Certificate Number: 181210172
207 South Union Street, Olean, New York 14760
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819) 16Service Type:
Program Name:
Certified Capacity:PRU 51754
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10172_Counci.pdf
Certificate Number: 190310173
1351 Olean Portville Road, Weston Mills, New York 14788
Effective: 01/01/2018 3/31/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Weston Manor
16Service Type:
Program Name:
Certified Capacity:PRU 51055
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10173_Counci.pdf
Certificate Number: 190910702
2nd Floor, 201 South Union Street, Olean, New York 14760
Effective: 06/05/2019 9/30/2019
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50770
with Telepractice Designation
86 South Main Street, Franklinville, NY 14737
Additional Location(s) At:
2nd Floor, Suite 205, 4039 Route 219, Salamanca, NY 14779
Additional Location(s) At:
1st Floor, 356 Main Street, Randolph, NY 14772
Additional Location(s) At:
Community Healthy Alliance, 1 School Street, Gowanda, NY 14070
Additional Location(s) At:
January 31, 2022 Page 55 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10702_Counci.pdf
Certificate Number: 210612232
1355 Olean Portville Road, , Weston Mills, New York 14788
Effective: 08/17/2020 6/30/2021
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Willow House 820 Residential
20Service Type:
Program Name:
Certified Capacity:PRU 53506
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12232_Counci.pdf
Council on Alcoholism and Other Chemical Dependencies of the Finger Lakes, Inc. d/b/a Council on Alcoholism
Mr. Timothy VanDamme, Executive Director
620 W Washington St, Geneva, NY 14456
Provider Number: 37250
Administrative Office:
Telephone - (315)-789-0310
Certificate Number: 230312010
Schuyler County-Admin Site, Watkins Glen, New York 14891-1615, 106 South Perry Street, 100 Main Street, and Yates County-Admin Site, , Penn Yan, New York 14527
Effective: 04/01/2020 3/31/2023
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90707
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90704
Watkins Glen Elementary School, 1st Floor, Room #447, 612 S. Decatur Street, Watkins Glen, NY 14891
Other Service Site(s) At:
Watkins Glen High School, 301 12th Street, Watkins Glen, NY 14891
Other Service Site(s) At:
Dundee Central School, 55 Water Street, Dundee, NY 14837
Other Service Site(s) At:
Penn Yan Elementary School, 3 School Drive, Penn Yan, NY 14527
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12010_Counci.pdf
Counseling Center at Yorktown Heights, LLC
Mr. Joseph Chelales, VP of Compliance
141 8th Street , Brentwood, NY 11717
Provider Number: 48620
Administrative Office:
Telephone - (646)-285-4035
Certificate Number: 230611810
2000 Maple Hill Street, Yorktown Heights, New York 10598
Effective: 07/01/2021 6/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52721
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11810_Counse.pdf
January 31, 2022 Page 56 of 227
Certificate Number: 220512266
141 8th Street, , Brentwood, New York 11717
Effective: 06/15/2021 5/31/2022
Program Location:
Establishment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
Sunrise Detox Brentwood
20Service Type:
Program Name:
Certified Capacity:PRU 53557
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Counseling Services of New York LLC
Mr. Brian Ketay, Operations Manager
Suite 1B, 911 Walton Avenue, Bronx, NY 10452
Provider Number: 44640
Administrative Office:
Telephone - (713)-818-6210
Certificate Number: 211011554
Suite 1B, 911 Walton Avenue, Bronx, New York 10452
Effective: 07/03/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52002
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11554_Counse.pdf
Credo Community Center for the Treatment of Addictions, Inc.
Mr. John C. Wilson, Executive Director
595 West Main Street, Watertown, NY 13601
Provider Number: 41270
Administrative Office:
Telephone - (315)-788-1530 Ext 105
Certificate Number: 210910744
595 West Main Street, , Watertown, New York 13601
Effective: 10/16/2019 9/30/2021
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 4986
with Telepractice Designation
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU 4986
First Floor West, 7714 Number Three Road, Lowville, NY 13367
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10744_CredoC.pdf
Certificate Number: 181211239
1st and 2nd Floors, 1130 State Street, Watertown, New York 13601
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Patricia Pond Hinckley Women's Residence
15Service Type:
Program Name:
Certified Capacity:PRU 7295
with Telepractice Designation
and up to 5 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11239_CredoC.pdf
January 31, 2022 Page 57 of 227
Certificate Number: 190111299
417 Washington Street, Watertown, New York 13601
Effective: 01/01/2018 1/31/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 16Service Type:
Program Name:
Certified Capacity:PRU 50262
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11299_CredoC.pdf
Certificate Number: 181211360
Basement,, 1st & 2nd Floors, 138 Winthrop Street, Watertown, New York 13601
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 15Service Type:
Program Name:
Certified Capacity:PRU 1589
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11360_CredoC.pdf
Certificate Number: 241011632
Jenkins Road, 24180 County Route 16, Evans Mills, New York 13637
Effective: 11/01/2021 10/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Rehabilitation Services for Youth (817) 14Service Type:
Program Name:
Certified Capacity:PRU 1347
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11632_CredoC.pdf
Certificate Number: 230112028
595 West Main Street, , Watertown, New York 13601
Effective: 02/01/2020 1/31/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 100Service Type:
Program Name:
Certified Capacity:PRU 52964
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12028_CredoC.pdf
Crouse Health Hospital, Inc.
Ms. Kimberly Boynton, Chief Executive Officer
736 Irving Avenue, Syracuse, NY 13210
Provider Number: 85010
Administrative Office:
Telephone - (315)-470-7376
Certificate Number: 230910439
2nd Floor, 2775 Erie Boulevard East, , Syracuse, New York 13224
Effective: 06/18/2021 9/30/2023
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Chemical Dependence Treatment Service
800Service Type:
Program Name:
Certified Capacity:PRU 1188
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10439_Crouse.pdf
January 31, 2022 Page 58 of 227
Certificate Number: 211010567
2nd Floor, 2775 Erie Boulevard East, , Syracuse, New York 13224
Effective: 06/18/2021 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Chemical Dependence Treatment Service
Service Type:
Program Name:
Certified Capacity:PRU 704
with Telepractice Designation
Outpatient Rehabilitation Service (822)
Chemical Dependence Treatment Service
Service Type:
Program Name:
Certified Capacity:PRU 50244
with Telepractice Designation
Commonwealth Place, 1st Floor, 6010 East Molloy Road, Syracuse, NY 13211
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10567_Crouse.pdf
Certificate Number: 210711698
6010 East Molloy Road, Syracuse, New York 13211
Effective: 08/01/2018 7/31/2021
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Commonwealth Place
40Service Type:
Program Name:
Certified Capacity:PRU 52249
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11698_Crouse.pdf
CS Medical Associates, P.C. d/b/a Victory Recovery Partners
Paolo Coppola M.D., Executive Director
Suites 1 & 2, 100 Granny Road, Farmingville, NY 11738
Provider Number: 50850
Administrative Office:
Telephone - (631)-696-4357
Certificate Number: 220112176
Suites 1 & 2, 100 Granny Road, , Farmingville, New York 11738
Effective: 08/03/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53315
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12176_CSMedi.pdf
Certificate Number: 210812235
Suites 15 & 16, 1st Floor, 2 Coraci Blvd, , Shirley, New York 11967
Effective: 09/02/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53503
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12235_CSMedi.pdf
Certificate Number: 210912240
2nd Floor, B1, 727 N. Broadway, , Massapequa, New York 11758
Effective: 10/19/2020 9/30/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53505
with Telepractice Designation [with ancillary withdrawal]
January 31, 2022 Page 59 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Delaware County Department of Mental Health
Ms. Cynthia Heaney, Director
243 Delaware Street, Walton, NY 13856
Provider Number: 70050
Administrative Office:
Telephone - (607)-832-5888
Certificate Number: 210510764
243 Delaware Street, , Walton, New York 13856
Effective: 06/05/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Delaware County Alcohol and Drug Service
Service Type:
Program Name:
Certified Capacity:PRU 50402
with Telepractice Designation
State University College of Technology at Delhi, 454 Delhi Drive, Delhi, NY 13753
Additional Location(s) At:
2nd Floor, Room 222, 21 Liberty Street, Sidney, NY 13838
Additional Location(s) At:
Margaretville Memorial Hospital, 1st Floor, Conference Room, 42084 State Highway 28, Margaretville, NY 12455
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10764_Delawa.pdf
Delaware Valley Hospital, Inc.
Mr. Rolland Bojo, President/CEO
One Titus Place, Walton, NY 13856
Provider Number: 81740
Administrative Office:
Telephone -
Certificate Number: 240311368
One Titus Place, Walton, New York 13856
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 10Service Type:
Program Name:
Certified Capacity:PRU 51166
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11368_Delawa.pdf
Delphi Drug and Alcohol Council, Inc. d/b/a Delphi Rise
Ms. Sue Sullivan, CEO
835 West Main Street, Rochester, NY 14611
Provider Number: 37290
Administrative Office:
Telephone -
Certificate Number: 210811260
835 West Main Street, Rochester, New York 14611
Effective: 01/24/2019 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 6797
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11260_Delphi.pdf
January 31, 2022 Page 60 of 227
Certificate Number: 220512008
Administrative Site Only:, 835 West Main Street, , Rochester, New York 14611
Effective: 09/14/2021 5/31/2022
Program Location:
Amendment Anticipated Recert Review:
Prevention Counseling 0Service Type:
Program Name:
Certified Capacity:PRU 90709
with Telepractice Designation
Newark High School, 1st Floor, Room 210, 625 Peirson Avenue, Newark, NY 14513
Other Service Site(s) At:
Sodus Middle School, 54 Miller Street, Sodus, NY 14551
Other Service Site(s) At:
Clyde-Savannah Elementary School, 215 Glasgow Street, Clyde, NY 14433
Other Service Site(s) At:
Williamson Middle School, 4184 Miller Street, Williamson, NY 14589
Other Service Site(s) At:
Ontario Elementary School, 1st Floor, Room 114, 1784 Ridge Road, Ontario Center, NY 14520
Other Service Site(s) At:
Wayne Technical & Career Center BOCES, 4440 Ridge Road, Williamson, NY 14589
Other Service Site(s) At:
Ontario Primary School, 1st Floor, Room A10, 1730 Ridge Road, Ontario Center, NY 14520
Other Service Site(s) At:
Newark Middle School, 1st Floor, Room 118, 701 Peirson Avenue, Newark, NY 14513
Other Service Site(s) At:
Norman R. Kelly Intermediate School, 1st Floor, Room 127, 316 West Miller Street, Newark, NY 14513
Other Service Site(s) At:
Lyons Middle/High School, 10 Clyde Road, Lyons, NY 14489
Other Service Site(s) At:
Sodus High School, 54 Miller Street, Sodus, NY 14551
Other Service Site(s) At:
Thomas C. Armstrong Middle School, 1st Floor, Room 118, 6076 Ontario Center Road, Ontario Center, NY 14520
Other Service Site(s) At:
North Rose-Wolcott High School, Counselor's Office, 11631 Salter Colvin Road, Wolcott, NY 14590
Other Service Site(s) At:
Perkins Elementary School, 1st Floor, Room 101, 439 West Maple Avenue, Newark, NY 14513
Other Service Site(s) At:
Sodus Elementary School, Route 88, Sodus, NY 14551
Other Service Site(s) At:
Lincoln Elementary School, 1st Floor, Speech Room #1B, 1014 North Main Street, Newark, NY 14513
Other Service Site(s) At:
Red Creek Elementary, Middle and High School, Rooms C80, C77, M17, M5, M7 & M8, 6574 South Street, Red Creek, NY 13143
Other Service Site(s) At:
Williamson Elementary School, 6036 Highland Avenue, Williamson, NY 14589
Other Service Site(s) At:
James A. Beneway High School, 1st Floor, Room 107, 6200 Ontario Center Road, Ontario Center, NY 14520
Other Service Site(s) At:
January 31, 2022 Page 61 of 227
North Rose-Wolcott Leavenworth Middle School, 3rd Floor, Counselor's Office, 5957 Hartford Street, Wolcott, NY 14590
Other Service Site(s) At:
Clyde Savannah Junior/Senior High School, 215 Glasgow Street, Clyde, NY 14433
Other Service Site(s) At:
Freewill Elementary School, 1st Floor, Room 131, 4320 Canandaigua Road, Walworth, NY 14568
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12008_Delphi.pdf
Certificate Number: 220112009
835 West Main Street, Rochester, New York 14611
Effective: 09/14/2021 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90708
with Telepractice Designation
Bay Trail Middle School, 1st Floor, Counseling Office 500L, 1760 Scribner Road, Penfield, NY 14526
Other Service Site(s) At:
Honeoye Falls Lima High School, 83 East Street , Honeoye, NY 14472
Other Service Site(s) At:
Paul Road Elementary, 1st Floor, Room 84, 571 Paul Road, Rochester, NY 14624
Other Service Site(s) At:
Gates Chili Middle School, 2 Spartan Way, Rochester, NY 14624
Other Service Site(s) At:
Honeoye Falls Lima Middle School, 619 Quaker Meeting House Road, Honeoye, NY 14472
Other Service Site(s) At:
Florence Brasser Elementary, 1st Floor, Room 122A, 1000 Chili Coldwater Road, Rochester, NY 14606
Other Service Site(s) At:
Gates Chili High School, 1 Spartan Way, Rochester, NY 14624
Other Service Site(s) At:
Cobbles Elementary School, 1st Floor, Conference Room 14J, 140 Gebhardt Road, Penfield, NY 14526
Other Service Site(s) At:
RCSD, Watertower Academy, 5th Floor, Room 516A, 175 Martin Street, Rochester, NY 14605
Other Service Site(s) At:
Neil Armstrong Elementary, 1st Floor, Room 40, 3273 Lyell Road, Rochester, NY 14606
Other Service Site(s) At:
Scribner Road Elementary School, 1st Floor, Conference Room 1BC, 1760 Scribner Road, Penfield, NY 14526
Other Service Site(s) At:
Oliver Middle School, 1st Floor, Room 133, 40 Allen Street, Brockport, NY 14420
Other Service Site(s) At:
Monroe 2 Orleans BOCES Career & Technical Education Center, 1st Floor, Room A-101, 3589 Big Ridge Road, Spencerport, NY 14559
Other Service Site(s) At:
Indian Landing Elementary School, 2nd Floor, Administration Office, 702 Landing Road North, Rochester, NY 14625
Other Service Site(s) At:
Brockport Senior High School, 40 Allen Street, Brockport, NY 14622
Other Service Site(s) At:
January 31, 2022 Page 62 of 227
Harris Hill Elementary School, 1st Floor, OT/PT Room 5, 2126 Penfield Road, Penfield, NY 14526
Other Service Site(s) At:
Twelve Corners Elementary School, 1st Floor , Family Support Office, 2035 Monroe Avenue, Rochester, NY 14618
Other Service Site(s) At:
Walt Disney Elementary, 1st Floor, Room 33, 175 Coldwater Road, Rochester, NY 14624
Other Service Site(s) At:
Penfield High School, 1st Floor, 25 High School Drive, Penfield, NY 14526
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12009_Delphi.pdf
The Department of Education of the Diocese of Brooklyn
Mr. Norwood Keaton, Executive Director
3rd Floor, 112-06 86th Avenue, Richmond Hill, NY 11418
Provider Number: 11460
Administrative Office:
Telephone - (718)-441-8921
Certificate Number: 241011985
Queens Central Office, 3rd Floor, 112-06 86th Avenue, Richmond Hill, New York 11418
Effective: 11/01/2021 10/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90758
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90757
St. Luke School, 16-01 150th Place, Whitestone, NY 11357
Other Service Site(s) At:
St. Mark School, 2602 East 19th Street, Brooklyn, NY 11235
Other Service Site(s) At:
St. Kevin Catholic Academy, 45-5 195th Street, Flushing, NY 11358
Other Service Site(s) At:
St. Sebastian School, 39-76 58th Street, Woodside, NY 11377
Other Service Site(s) At:
Our Lady's Catholic Academy @ 128 St. Campus, 109-55 128th Street, South Ozone Park, NY 11420
Other Service Site(s) At:
Xaverian High School, 7100 Shore Road, Brooklyn, NY 11209
Other Service Site(s) At:
O. L. Guadalupe School, 1518 73rd Street, Brooklyn, NY 11228
Other Service Site(s) At:
Holy Angels Catholic Academy, 347 74th Street, Brooklyn, NY 11209
Other Service Site(s) At:
St. Francis DeSales Catholic Academy, 219 Beach 129th Street, Belle Harbor, NY 11694
Other Service Site(s) At:
Immaculate Conception School, 179-14 Dalny Road, Jamaica, NY 11432
Other Service Site(s) At:
St. Clare Catholic Academy, 137-25 Brookville Boulevard, Rosedale, NY 11422
Other Service Site(s) At:
Sacred Heart School, 38th Avenue/216th Street, Bayside, NY 11361
Other Service Site(s) At:
January 31, 2022 Page 63 of 227
Holy Trinity Catholic Academy, 14-45 143rd Street, Whitestone, NY 11357
Other Service Site(s) At:
St. Elizabeth Catholic Academy, 94-01 85th Street, Ozone Park, NY 11416
Other Service Site(s) At:
St. Bernard School, 2030 East 69th Street, Brooklyn, NY 11234
Other Service Site(s) At:
Blessed Sacrament School, 187 Euclid Avenue, Brooklyn, NY 11208
Other Service Site(s) At:
St. Francis Prep High School, 6100 Francis Lewis Boulevard, Fresh Meadows, NY 11365
Other Service Site(s) At:
Immaculate Conception School, 21-63 29th Street, Long Island City, NY 11105
Other Service Site(s) At:
O. L. Grace School, 385 Avenue W, Brooklyn, NY 11223
Other Service Site(s) At:
O. L. Mercy Catholic Academy, 7025 Kessel Street, Forest Hills, NY 11375
Other Service Site(s) At:
Archbishop Molloy High School, 83-53 Manton Street, Jamaica, NY 11435
Other Service Site(s) At:
St. Adalbert, 52-17 83rd Street, Elmhurst, NY 11373
Other Service Site(s) At:
Christo Rey Brooklyn High School, 710 East 37th Street, Brooklyn, NY 11238
Other Service Site(s) At:
Notra Dame Catholic Academy, 61st & Bleecker Streets, Ridgewood, NY 11385
Other Service Site(s) At:
Most Holy Redeemer Catholic Academy, 136-58 41st Avenue, Flushing, NY 11355
Other Service Site(s) At:
Midwood Catholic Academy, 1501 Hendrickson Street, Brooklyn, NY 11204
Other Service Site(s) At:
St. Mel Catholic Academy, 154-24 26th Avenue, Flushing, NY 11354
Other Service Site(s) At:
St. Edmund School, Avenue T/East 19th Street, Brooklyn, NY 11229
Other Service Site(s) At:
St. Francis Assisi Catholic Academy, 400 Lincoln Road, Brooklyn, NY 11225
Other Service Site(s) At:
St. Joseph High School, 80 Willoughby Street, Brooklyn, NY 11201
Other Service Site(s) At:
St. Agnes Academic High School, 13-20 124th Street, College Point, NY 11356
Other Service Site(s) At:
St. Thomas Apostle, 87-49 87th Street, Woodhaven, NY 11421
Other Service Site(s) At:
St. Pancras, 68-20 Myrtle Avenue, Glendale, NY 11385
Other Service Site(s) At:
Bishop Kearney High School, 60th Street/Bay Parkway, Brooklyn, NY 11204
Other Service Site(s) At:
Monsignor McClancy, 71-06 31st Avenue, East Elmhurst, NY 11370
Other Service Site(s) At:
St. Francis Cabrini Catholic Academy, 181 Suydam Street, Brooklyn, NY 11221
Other Service Site(s) At:
January 31, 2022 Page 64 of 227
St. Rose of Lima Catholic Academy, 154 Beach 84th Street, Rockaway Beach, NY 11693
Other Service Site(s) At:
Good Shepherd School, 1943 Brown Street, Brooklyn, NY 11229
Other Service Site(s) At:
St. Leo School, 104-19 49th Avenue, Corona, NY 11368
Other Service Site(s) At:
The Mary Louis Academy, 176-21 Wexford Terrace, Jamaica, NY 11432
Other Service Site(s) At:
St. Saviour High School, 588 6th Street, Brooklyn, NY 11215
Other Service Site(s) At:
Divine Wisdom Catholic Academy, 45-11 245th Street, Douglaston, NY 11363
Other Service Site(s) At:
Holy Cross High School, 26-20 Francis Lewis Boulevard, Flushing, NY 11358
Other Service Site(s) At:
St. Helen Catholic Academy, 82-09 157th Avenue, Howard Beach, NY 11414
Other Service Site(s) At:
Fontbonne Hall Academy, 9901 Shore Road, Brooklyn, NY 11209
Other Service Site(s) At:
St. Francis Xavier Catholic Academy, 763 President Street, Brooklyn, NY 11215
Other Service Site(s) At:
St. Camillus Catholic Academy, 185 Beach 99th Street, Rockaway Beach, NY 11694
Other Service Site(s) At:
Queens Field Office, Holy Child Convent, 112-06 86th Avenue, Richmond Hill, NY 11418
Other Service Site(s) At:
Resurrection Ascension School, 85-25 61st Road, Rego Park, NY 11374
Other Service Site(s) At:
St. Francis Assisi, 21-18 46th Street, Long Island City, NY 11105
Other Service Site(s) At:
St. Nicholas Tolentine School, 80-22 Parsons Boulevard, Jamaica, NY 11432
Other Service Site(s) At:
St. Gregory the Great Catholic Academy, 2520 Church Avenue, Brooklyn, NY 11226
Other Service Site(s) At:
Incarnation School, 89-15 Francis Lewis Boulevard, Queens Village, NY 11427
Other Service Site(s) At:
St. Ephrem School, 741 5 Ft. Hamilton Parkway, Brooklyn, NY 11228
Other Service Site(s) At:
Cathedral Prep School and Seminary, 56-25 92nd Street, Elmhurst, NY 11373
Other Service Site(s) At:
O. L. Trust Catholic Academy, 1696 Canarsie Road, Brooklyn, NY 11236
Other Service Site(s) At:
Sacred Heart Catholic Academy, 115-50 221st Street, Cambria Heights, NY 11411
Other Service Site(s) At:
Queen of the Rosary Catholic Academy, 11 Catherine Street, Brooklyn, NY 11211
Other Service Site(s) At:
St. Savious Catholic Academy, 701 8th Avenue, Brooklyn, NY 11215
Other Service Site(s) At:
Nazareth Regional High School, East 57th/Avenue D, Brooklyn, NY 11203
Other Service Site(s) At:
January 31, 2022 Page 65 of 227
St. Margaret School, 66-10 80th Street, Middle Village, NY 11379
Other Service Site(s) At:
O. L. Lourdes Catholic Academy, 92-80 220th Street, Queens Village, NY 11428
Other Service Site(s) At:
Mary Queens of Heaven, 1326 East 57th Street, Brooklyn, NY 11234
Other Service Site(s) At:
St. Brigid Catholic Academy, 438 Grove Street, Brooklyn, NY 11237
Other Service Site(s) At:
St. Mary Gate of Heaven School, 104-06 101st Avenue, Ozone Park, NY 11416
Other Service Site(s) At:
St. Athanasius School, 6120 Bay Parkway, Brooklyn, NY 11204
Other Service Site(s) At:
St. Bartholomew School, 44-15 Judge Street, Elmhurst, NY 11373
Other Service Site(s) At:
St. Joseph Catholic Academy, 28-46 44th Street, Long Island City, NY 11103
Other Service Site(s) At:
St. Agatha School, 736 48th Street, Brooklyn, NY 11220
Other Service Site(s) At:
Ava Maria Catholic Academy, 158-20 101st Street, Howard Beach, NY 11414
Other Service Site(s) At:
Holy Child Jesus Catholic Academy, 86th Avenue/111th Street, Richmond Hill, NY 11418
Other Service Site(s) At:
O. L. Perpetual Help Catholic Academy, 111-10 115th Street, South Ozone Park, NY 11420
Other Service Site(s) At:
Devine Wisdom Catholic Academy - Bayside Campus, 56-10 214th Street, Bayside, NY 11364
Other Service Site(s) At:
St. Francis Cabrini, 21 Bay 11th Street, Brooklyn, NY 11208
Other Service Site(s) At:
Holy Family, 74-15 175th Street, Flushing, NY 11366
Other Service Site(s) At:
Sacred Heart School, 84-05 78th Avenue, Glendale, NY 11385
Other Service Site(s) At:
O. L. Snows School, 79-33 258th Street, North Floral Park, NY 11004
Other Service Site(s) At:
O. L. Fatima School, 25-38 80th Street, Jackson Heights, NY 11370
Other Service Site(s) At:
St. Stanislaus Kostka Catholic Academy, 10 Newell Street, Brooklyn, NY 11222
Other Service Site(s) At:
Christ the King Regional High School, 68-02 Metropolitan Avenue, Middle Village, NY 11379
Other Service Site(s) At:
Bishop Loughlin Memorial High School, 357 Clermont Avenue, Brooklyn, NY 11238
Other Service Site(s) At:
Visitation Academy, Ridge Boulevard/89th Street, Brooklyn, NY 11209
Other Service Site(s) At:
St. Joseph the Worker Catholic Academy, 241 Prospect Park West, Brooklyn, NY 11215
Other Service Site(s) At:
St. Patrick Catholic Academy, 420 95th Street, Brooklyn, NY 11209
Other Service Site(s) At:
January 31, 2022 Page 66 of 227
O. L. Queen of Martyrs School, 72-55 Austin Street, Forest Hills, NY 11375
Other Service Site(s) At:
O. L. Hope School, 61-21 71st Street, Middle Village, NY 11379
Other Service Site(s) At:
O. L. Sorrows Catholic Academy, 35-34 105th Street, Corona, NY 11368
Other Service Site(s) At:
O. L. Angelus Catholic Academy, 98-05 63rd Drive, Rego Park, NY 11374
Other Service Site(s) At:
St. Gregory the Great School, 244-44 87th Street, Bellerose, NY 11426
Other Service Site(s) At:
Divine Mercy Catholic Academy, 101-60 90th Street, Ozone Park, NY 11416
Other Service Site(s) At:
St. Stanislaus Kostka School, 61-17 Grand Avenue, Maspeth, NY 11378
Other Service Site(s) At:
Queen of All Saints, 300 Vanderbilt Avenue, Brooklyn, NY 11205
Other Service Site(s) At:
Salve Regina Catholic Academy, 237 Jerome Street, Brooklyn, NY 11207
Other Service Site(s) At:
Catholic Academy of Brooklyn, 5902 6th Avenue, Brooklyn, NY 11220
Other Service Site(s) At:
St. Peter's Catholic Academy, 8401 23rd Avenue, Brooklyn, NY 11214
Other Service Site(s) At:
St. Andrew of Avellino School, 35-50 158th Street, Flushing, NY 11358
Other Service Site(s) At:
O. L. Catholic Academy @ Rockaway Boulevard Campus, 125-18 Rockaway Boulevard, South Ozone Park, NY 11420
Other Service Site(s) At:
Brooklyn Field Office, St. Agatha Convent, 746 48th Street, Brooklyn, NY 11220
Other Service Site(s) At:
St. Edmund Preparatory High School, 2474 Ocean Avenue, Brooklyn, NY 11229
Other Service Site(s) At:
SS Joachim & Anne School, 218-19 105th Avenue, Queens Village, NY 11429
Other Service Site(s) At:
St. Catherine Genoa/St. Therese Lixieux C.A., 4410 Avenue D, Brooklyn, NY 11203
Other Service Site(s) At:
St. John's Preparatory High School, Crescent Street/21st Avenue, Astoria, NY 11105
Other Service Site(s) At:
O. L. Blessed Sacrament School, 34-45 202nd Street, Flushing, NY 11361
Other Service Site(s) At:
St. Anselm Catholic Academy, 83rd Street/4th Avenue, Brooklyn, NY 11209
Other Service Site(s) At:
St. Matthias School, 58-25 Catalpa Avenue, Ridgewood, NY 11385
Other Service Site(s) At:
St. Joan of Arc, 35-27 82nd Street, Jackson Heights, NY 11372
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11985_Depart.pdf
January 31, 2022 Page 67 of 227
Department of Education, Archdiocese of New York
Ms. Christine Cavallucci, Executive Director
2789 Schurz Avenue, Bronx, NY 10465
Provider Number: 27080
Administrative Office:
Telephone - (718)-904-1333 Ext 13
Certificate Number: 230211994
Administrative Office, 2789 Schurz Avenue, Bronx, New York 10465
Effective: 08/20/2021 2/28/2023
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90837
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90833
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90835
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90838
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90839
with Telepractice Designation
Albertus Magnus High School, 1st Floor, ADAPP Office, 798 Route 304, Germonds, Bardonia, NY 10954
Other Service Site(s) At:
St. Denis/St. Columba School, 1st Floor, ADAPP Room,
St. Paul School, 365 Kings Highway, Valley Cottage, NY 10989
Other Service Site(s) At:
Our Lady of Mt. Carmel School, 2nd Floor, Library, 59 East Main Street, Elmsford, NY 10523
Other Service Site(s) At:
St. Anthony School, Annex, 1st Floor, ADAPP Office, 34 West Nyack Road, Nanuet, NY 10954
Other Service Site(s) At:
Immaculate Conception, Winterhill Road, Tuckahoe, NY 10707
Other Service Site(s) At:
St. Mary School, 1st Floor, Art Room, 2 Convent Avenue, Wappingers Falls, NY 12590
Other Service Site(s) At:
Sacred Heart School, 60 Washington Avenue, Suffern, NY 10901
Other Service Site(s) At:
San Miguel Academy, 241 Liberty Street, Newburgh, NY 12550
Other Service Site(s) At:
John F. Kennedy HS, 54 Route 138, Somers, NY 10589
Other Service Site(s) At:
Sacred Heart/St. Francis School, Basement, ADAPP Office, 24 South Robinson Avenue, Newburgh, NY 12550
Other Service Site(s) At:
Sacred Heart High School, Basement, Room B4, 34 Convent Avenue, Yonkers, NY 10703
Other Service Site(s) At:
January 31, 2022 Page 68 of 227
Our Lady of Victory School, 2nd Floor, Art Room, 38 North Fifth Avenue, Mount Vernon, NY 10550
Other Service Site(s) At:
St. John School, 77 Murray Avenue, Goshen, NY 10924
Other Service Site(s) At:
Holy Trinity School, 1st Floor, ADAPP Room, 20 Springside Avenue, Poughkeepsie, NY 12603
Other Service Site(s) At:
John S. Burke Catholic High School, 1st Floor, ADAPP OFFICE, 80 Fletcher Street, Goshen, NY 10924
Other Service Site(s) At:
Our Lady of Lourdes High School, 2nd Floor, Room 201, 131 Boardman Road, Poughkeepsie, NY 12603
Other Service Site(s) At:
Our Lady of Mt. Carmel School, 205 Wawayanda Avenue, Middletown, NY 10940
Other Service Site(s) At:
Sacred Heart Elementary School, 2nd Floor, Library/Computer Room, 34 Convent Avenue, Yonkers, NY 10703
Other Service Site(s) At:
St. Gregory Barbarigo School, 29 Cinder Road, Garnerville, NY 10932
Other Service Site(s) At:
Salesian High School, 3rd Floor, Room 403, 148 Main Street, New Rochelle, NY 10801
Other Service Site(s) At:
St. Margaret School, 33 North Magnolia Street, Pearl River, NY 10965
Other Service Site(s) At:
St. Augustine School, 1st Floor, ADAPP Office, Route 9, Eagle Park, Ossining, NY 10562
Other Service Site(s) At:
St. Mary, Mother of the Church, 1st Floor, Library/Computer Room, 100 Jackson Street, Fishkill, NY 12524
Other Service Site(s) At:
John A. Coleman High School, 430 Hurley Avenue, Hurley, NY 12443
Other Service Site(s) At:
Corpus Christi School, 3rd Floor, Resource Room, 135 South Regent Street, Port Chester, NY 10573
Other Service Site(s) At:
Annunciation School, 1st Floor, Music/Teacher Room, 465 Westchester Avenue, Yonkers, NY 10707
Other Service Site(s) At:
St. John & Paul, 280 Weaver Street, Larchmont, NY 10538
Other Service Site(s) At:
Bishop Dunn Memorial School, 50 Gidney Avenue, Newburgh, NY 12550
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11994_Depart.pdf
January 31, 2022 Page 69 of 227
Certificate Number: 230212006
Administrative Site Only:, 2789 Schurz Avenue, Bronx, New York 10465
Effective: 08/20/2021 2/28/2023
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90771
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90834
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90836
with Telepractice Designation
1st Floor, ADAPP Office, 3893 Dyre Avenue, Bronx, NY 10466
Other Service Site(s) At:
Santa Maria School, 2nd Floor, Adjacent to 4th & 5th Grade Classrooms, 1510 Zerega Avenue, Bronx, NY 10462
Other Service Site(s) At:
St. Peter's Boys High School, 4th Floor, Adjacent to Room 402, 200 Clinton Avenue, Staten Island, NY 10301
Other Service Site(s) At:
St. Jean Baptiste High School, 5th Floor, 173 East 75th Street, New York, NY 10021
Other Service Site(s) At:
St. Frances de Chantal, 4th Floor, Room 406, 2962 Harding Avenue, Bronx, NY 10465
Other Service Site(s) At:
St. Brigid School, 185 East 7th Street, New York, NY 10009
Other Service Site(s) At:
St. Adalbert School, 355 Morningstar Road, Staten Island, NY 10303
Other Service Site(s) At:
St. Margaret Mary School, 3rd Floor, ADAPP Office, 121 East 177th Street, Bronx, NY 10453
Other Service Site(s) At:
Our Lady Star of the Sea, 1st Floor, ADAPP Office, 5411 Amboy Road, Staten Island, NY 10312
Other Service Site(s) At:
Our Lady Queen of Peace School, 22 Steele Avenue, Staten Island, NY 10306
Other Service Site(s) At:
St. Angela Merici School, 266 East 163rd Street, Bronx, NY 10451
Other Service Site(s) At:
Moore Catholic High School, 1st Floor, Room CV4, 100 Merrill Avenue, Staten Island, NY 10314
Other Service Site(s) At:
Our Lady Queen of Angels School, 229 East 112th Street, New York, NY 10029
Other Service Site(s) At:
Msgr. Scanlan High School, 3 1/2 Floor, Room 6, 915 Hutchinson River Parkway, Bronx, NY 10465
Other Service Site(s) At:
St. Joseph's Hill Academy, 850 Hylan Boulevard, Staten Island, NY 10305
Other Service Site(s) At:
Cardinal Hayes High School, Mezzanine, ADAPP Office, 650 Grand Concourse, Bronx, NY 10451
Other Service Site(s) At:
St. Benedict School, Ground Floor, The After School Room, 1016 Edison Avenue, Bronx, NY 10465
Other Service Site(s) At:
January 31, 2022 Page 70 of 227
St. Ann School, 125 Cromwell Avenue, Staten Island, NY 10304
Other Service Site(s) At:
Preston High School, 3rd Floor, Office, 2780 Schurz Avenue, Bronx, NY 10465
Other Service Site(s) At:
Mt. St. Michael Academy, 3rd Floor, Room 314, 4300 Murdock Avenue, Bronx, NY 10466
Other Service Site(s) At:
Immaculate Conception, 1st Floor, Mezzanine, Title I Office, 419 East 13th Street, New York, NY 10009
Other Service Site(s) At:
St. Mark the Evangelist, 55 West 138th Street, New York, NY 10037
Other Service Site(s) At:
Academy of Mt. St. Ursula, 3rd Floor, Room 311, 330 Bedford Park Boulevard, Bronx, NY 10458
Other Service Site(s) At:
St. Joseph School, 2nd Floor, Room 201, 1946 Bathgate Avenue, Bronx, NY 10457
Other Service Site(s) At:
Sacred Heart School, 4th Floor, ADAPP Office, 95 West 168th Street, Bronx, NY 10452
Other Service Site(s) At:
Cathedral High School, 350 East 56th Street, New York, NY 10022
Other Service Site(s) At:
St. Mary School, 3956 Carpenter Avenue, Bronx, NY 10466
Other Service Site(s) At:
St. Athanasius, 3rd Floor, Art Room, 830 Southern Boulevard, Bronx, NY 10459
Other Service Site(s) At:
St. John Villa Elementary School Building C, 3rd Floor, Room 303, ADAPP Office, 57 Cleveland Place, Staten Island, NY 10305
Other Service Site(s) At:
Holy Rosary School, 1500 Arnow Avenue, Bronx, NY 10469
Other Service Site(s) At:
Holy Rosary Elementary School, Basement, Library, 100 Jerome Avenue, Staten Island, NY 10305
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12006_Depart.pdf
Dutchess County Department of Behavioral and Community Health (DBCH)
Ms. Jean Marie Niebuhr, Director and Deputy Commissioner of Community Services
230 North Road, Poughkeepsie, NY 12601
Provider Number: 70180
Administrative Office:
Telephone - 845-486-2885
Certificate Number: 210810628
230 North Road, , Poughkeepsie, New York 12601
Effective: 03/15/2021 8/31/2021
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51770
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51924
with Telepractice Designation
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
with Telepractice Designation
January 31, 2022 Page 71 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10628_Dutche.pdf
Dynamic Youth Community, Inc.
Mr. William A. Fusco, Executive Director
1830 Coney Island Avenue, Brooklyn, NY 11230
Provider Number: 105
Administrative Office:
Telephone - (718)-376-7923
Certificate Number: 190210005
Main Building, Women's, Dorm and Men's Dorm, 5803 Route 42, Fallsburg, New York 12733
Effective: 01/01/2018 2/28/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 86Service Type:
Program Name:
Certified Capacity:PRU 813
with Telepractice Designation Main Building - 52 beds for men; Men's Dorm - 10 beds for men; and Women's Dorm - 24 beds for women
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10005_Dynami.pdf
Certificate Number: 210811509
1830 Coney Island Avenue, Brooklyn, New York 11230
Effective: 06/22/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 528
with Telepractice Designation
1808 Coney Island Avenue, Brooklyn, NY 11230
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11509_Dynami.pdf
Certificate Number: 181211663
1830 Coney Island Avenue, Brooklyn, New York 11230
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 16Service Type:
Program Name:
Certified Capacity:PRU 52160
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11663_Dynami.pdf
EAC, Inc.
Ms. Tania Peterson Chandler, Interim President & CEO
Suite 107, 50 Clinton Street, Hempstead, NY 11550
Provider Number: 33030
Administrative Office:
Telephone - (516)-539-0150
Certificate Number: 220111510
Suite 403, 4th Floor, 175 Fulton Avenue, , Hempstead, New York 11550
Effective: 09/04/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
EAC Outpatient Clinic
Service Type:
Program Name:
Certified Capacity:PRU 6815
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11510_EACInc.pdf
January 31, 2022 Page 72 of 227
Eastern Niagara Hospital, Inc.
Ms. Anne McCaffrey, Chief Executive Officer
521 East Avenue, Lockport, NY 14094
Provider Number: 81760
Administrative Office:
Telephone - (716)-514-5502
Certificate Number: 220311372
North Building, 3rd Floor, 521 East Avenue, , Lockport, New York 14094
Effective: 04/04/2020 3/31/2022
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Reflections Recovery Centre
30Service Type:
Program Name:
Certified Capacity:PRU 51208
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11372_Easter.pdf
EBDK at Calverton, LLC d/b/a Wellbridge
Mr. Christopher Yadron, Chief Executive Officer
525 Jan Way, Calverton, NY 11933
Provider Number: 51130
Administrative Office:
Telephone - (516)-841-6363
Certificate Number: 220312209
, New York
Effective: 10/01/2021 3/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Wellbridge Rehabilitation Program
50Service Type:
Program Name:
Certified Capacity:PRU 53478
with up to 8 beds for the provision of Part 816.7 medically supervised withdrawal and stabilization services with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12209_EBDKat.pdf
Certificate Number: 220312216
525 Jan Way, , Calverton, New York 11933
Effective: 10/01/2021 3/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
Wellbridge Stabilization Program
10Service Type:
Program Name:
Certified Capacity:PRU 53476
with up to 8 beds for the provision of Part 818 inpatient rehabilitation services with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12216_EBDKat.pdf
Certificate Number: 210412217
525 Jan Way, , Calverton, New York 11933
Effective: 03/15/2021 4/30/2021
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Wellbridge Residential Program
8Service Type:
Program Name:
Certified Capacity:PRU 53477
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12217_EBDKat.pdf
The Educational Alliance, Inc.
Mr. Alan vanCapelle, President and CEO
197 East Broadway, New York, NY 10002
Provider Number: 70590
Administrative Office:
Telephone - (646)-395-4060
January 31, 2022 Page 73 of 227
Certificate Number: 230611537
New Side, 1st, 2nd and 3rd Floors, 25-29 Avenue D, New York, New York 10009
Effective: 07/01/2021 6/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Project Contact
Service Type:
Program Name:
Certified Capacity:PRU 55
with Telepractice Designation
150 William Street, New York, NY 10038
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11537_Educat.pdf
Certificate Number: 240312073
Original Side, New Side - 4th - 6th Floor, Basement - 6th Floor, 25-29 Avenue D, New York, New York 10009
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Pride Site
100Service Type:
Program Name:
Certified Capacity:PRU 53069
with Telepractice Designation [16 beds for women only - 4th Floor]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12073_TheEdu.pdf
EHS, Inc.
Mr. Raymond Ganoe, President/CEO
206 South Elmwood Avenue, Buffalo, NY 14201
Provider Number: 38260
Administrative Office:
Telephone - (716)-847-2441
Certificate Number: 220911877
4th Floor, 206 South Elmwood Avenue, Buffalo, New York 14201
Effective: 05/04/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52843
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11877_EHSInc.pdf
Elev8 Center New York, LLC
Ms. Donna Mae DePola, Executive Director
151 West 136th Street, New York, NY 10030
Provider Number: 50200
Administrative Office:
Telephone - (646)-819-0827
Certificate Number: 220812151
3rd Floor, 151 West 136th Street, New York, New York 10030
Effective: 08/21/2020 8/31/2022
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 37Service Type:
Program Name:
Certified Capacity:PRU 53268
with Telepractice Designation [Up to 14 of these beds, in Room #s 302 & 303, may be used for the provision of Medically Supervised Inpatient Withdrawal and Stabilization, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12151_Elev8C.pdf
January 31, 2022 Page 74 of 227
Certificate Number: 221212153
2nd Floor, 151 West 136th Street, New York, New York 10030
Effective: 01/01/2020 12/31/2022
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 38Service Type:
Program Name:
Certified Capacity:PRU 53270
with Telepractice Designation- with the use of methadone [Up to 18 of these beds, on the 2nd Floor in Room #s 202 & 204, may be used for the provision of Inpatient Rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12153_Elev8C.pdf
Elmcor Youth & Adult Activities, Inc.
Ms. Saeeda Dunston, Executive Director
2nd Floor, 107-20 Northern Boulevard, Corona, NY 11368
Provider Number: 114
Administrative Office:
Telephone - (718)-651-0096 Ext 237
Certificate Number: 181211300
(Residential), 107-06 Northern Boulevard, Basement, 1st, 2nd Floors, (Counseling)Basement, 1st Floor, Corona, New York 11368, 107-20 Northern Boulevard, Corona, New York 11368
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 51Service Type:
Program Name:
Certified Capacity:PRU 1283
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11300_Elmcor.pdf
Certificate Number: 210611512
1st Floor, 107-20 Northern Boulevard, , Corona, New York 11368
Effective: 03/05/2019 6/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 458
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11512_Elmcor.pdf
Certificate Number: 231011969
2nd Floor, 33-16 108th Street, , Corona, New York 11368
Effective: 11/01/2021 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90736
with Telepractice Designation
I.S. 127, 4th Floor, 9801 25th Avenue, East Elmhurst, NY 11369
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11969_Elmcor.pdf
Employee Assistance Resource Services, Inc.
Dr Simon D. Zysman Ph.D., Founder and President
Suite B, 278 East Main Street, Smithtown, NY 11787
Provider Number: 1413
Administrative Office:
Telephone - (516)-361-6960
January 31, 2022 Page 75 of 227
Certificate Number: 240510768
278 East Main Street, Smithtown, New York 11787
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 4164
[with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10768_Employ.pdf
EPIC Family of Human Service Agencies, Inc. as Sponsor, South Shore Child Guidance Association Inc, dba So
Mr Thomas Hopkins, CEO
91 Guy Lombardo Avenue, Freeport, NY 11520
Provider Number: 50580
Administrative Office:
Telephone - (516)-739-7733 Ext 100
Certificate Number: 230611999
91 Guy Lombardo Avenue, Freeport, New York 11520
Effective: 11/23/2021 6/30/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Children's Addiction Resources and Education Center (C.A.R.E.)
Service Type:
Program Name:
Certified Capacity:PRU 52960
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11999_EPICFa.pdf
Equinox, Inc.
Ms. Virginia Golden, Chief Executive Officer
500 Central Avenue, Albany, NY 12206
Provider Number: 14510
Administrative Office:
Telephone - (518)-435-9931 Ext 5240
Certificate Number: 220511801
1st Floor, 500 Central Avenue, , Albany, New York 12206
Effective: 06/01/2021 5/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)
Counseling Center
Service Type:
Program Name:
Certified Capacity:PRU 52689
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11801_Equino.pdf
Erie County Medical Center Corporation
Thomas J. Quatroche Jr, Ph.D., President and CEO
462 Grider Street, Buffalo, NY 14215
Provider Number: 85150
Administrative Office:
Telephone - (716)-898-3000
Certificate Number: 240810282
Zone 3 (18 beds), 9th Floor, 462 Grider Street, Zone 4 (14 beds), Buffalo, New York 14215
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Medically Managed Withdrawal & Stabilization Services (816.6) 32Service Type:
Program Name:
Certified Capacity:PRU 50276
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10282_ErieCo.pdf
January 31, 2022 Page 76 of 227
Certificate Number: 240610770
1st Floor, 2005 Sheridan Drive, , Tonawanda, New York 14223
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Northern Erie Clinical Services
Service Type:
Program Name:
Certified Capacity:PRU 50282
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10770_ErieCo.pdf
Certificate Number: 240610771
2nd Floor, 1285 Main Street, Buffalo, New York 14209
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50278
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10771_ErieCo.pdf
Certificate Number: 210311369
9th Floor, Zone 1, 462 Grider Street, Buffalo, New York 14215
Effective: 04/01/2018 3/31/2021
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 20Service Type:
Program Name:
Certified Capacity:PRU 50277
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11369_ErieCo.pdf
Certificate Number: 240611811
5087 Broadway, Depew, New York 14043
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52700
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11811_ErieCo.pdf
Exodus Transitional Community, Inc.
Mr. Julio Medina, Executive Director
2271 3rd Avenue, New York, NY 10035
Provider Number: 49050
Administrative Office:
Telephone - (917)-492-0990 Ext 175
Certificate Number: 210211947
2nd & 3rd Floors, 2271 3rd Avenue, New York, New York 10035
Effective: 03/01/2019 2/28/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52922
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11947_Exodus.pdf
Exponents, Inc.
Mr. Joseph Turner J.D., President and Chief Executive Officer
8th Floor, 17 Battery Place, New York, NY 10004
Provider Number: 2015
Administrative Office:
Telephone - (212)-243-3434 Ext 339
January 31, 2022 Page 77 of 227
Certificate Number: 221010773
8th Floor, 17 Battery Place, New York, New York 10004
Effective: 06/02/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7128
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10773_Expone.pdf
Fairview Recovery Services, Inc.
Mr. Patrick Haley LMSW, Executive Director
5 Merrick Street, Binghamton, NY 13904
Provider Number: 36020
Administrative Office:
Telephone - (607)-722-8987 Ext 224
Certificate Number: 190610143
5 Merrick Street, , Binghamton, New York 13904
Effective: 01/01/2018 6/30/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819)
Fairview Supportive Living Program
45Service Type:
Program Name:
Certified Capacity:PRU 50092
with Telepractice Designation for adults and their children {case records and administrative offices are located at 116 Fairview Avenue, Binghamton}
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10143_Fairvi.pdf
Certificate Number: 200312085
Basement & 1st Floor, 247 Court Street, Binghamton, New York 13901
Effective: 04/01/2019 3/31/2020
Program Location:
Extended Establishmen Anticipated Recert Review:
Residential Services (820) 20Service Type:
Program Name:
Certified Capacity:PRU 53123
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12085_Fairvi.pdf
Certificate Number: 200212166
8 Clapham Street, , Binghamton, New York 13904
Effective: 04/10/2019 2/29/2020
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
New Outlook
18Service Type:
Program Name:
Certified Capacity:PRU 53301
with Telepractice Designation [adult beds are for women]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12166_Fairvi.pdf
Certificate Number: 200212167
5 Merrick Street, , Binghamton, New York 13904
Effective: 04/10/2019 2/29/2020
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Fairview Recovery Services
24Service Type:
Program Name:
Certified Capacity:PRU 53302
with Telepractice Designation [for men]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12167_Fairvi.pdf
January 31, 2022 Page 78 of 227
Family & Children's Service of the Capital Region, Inc. d/b/a Capital Counseling
Ms. Kandie Sawyer, Chief Executive Office
650 Warren Street, Albany, NY 12208
Provider Number: 26330
Administrative Office:
Telephone - (518)-462-6531 Ext 114
Certificate Number: 211012242
1st Floor, 650 Warren Street, , Albany, New York 12208
Effective: 11/18/2020 10/31/2021
Program Location:
Establishment Anticipated Recert Review:
Chemical Dependency Specialized Services (824)
Center for Problem Gambling
0Service Type:
Program Name:
Certified Capacity:PRU 53502
with Problem Gambling designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Family and Children's Association
Mr. Jeffrey L. Reynolds, President/CEO
Suite 24, 100 East Old Country Road, Mineola, NY 11501
Provider Number: 30120
Administrative Office:
Telephone - (516)-746-0350
Certificate Number: 221210774
180 Broadway, Hicksville, New York 11801
Effective: 01/01/2021 12/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Hicksville Drug Counseling Center
Service Type:
Program Name:
Certified Capacity:PRU 50923
[with ancillary withdrawal services] with Telepractice Designation
126 North Franklin Street, Hempstead, NY 11550
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10774_Family.pdf
Certificate Number: 221111966
126 North Franklin Street, Hempstead, New York 11550
Effective: 12/01/2019 11/30/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90665
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11966_Family.pdf
Family Counseling Services of Cortland County, Inc.
Ms. Lisa W. Hoeschele, CEO & Executive Director
Suite B, 1st Floor, 165-177 Main Street, Cortland, NY 13045
Provider Number: 36350
Administrative Office:
Telephone - (607)-753-0234
Certificate Number: 211110777
1st Floor, 165-177 Main Street, Cortland, New York 13045
Effective: 04/15/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50991
with Telepractice Designation
1st Floor, 257 Main Street, Binghamton, NY 13905
Additional Location(s) At:
201 Cedar Street, Oneida, NY 13421
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10777_Family.pdf
January 31, 2022 Page 79 of 227
Family Service League, Inc.
Ms. Karen Boorshtein, President and Chief Executive Officer
790 Park Avenue, Huntington, NY 11743
Provider Number: 50440
Administrative Office:
Telephone - (631)-470-6780
Certificate Number: 220510635
1448 Fifth Avenue, , Bayshore, New York 11706
Effective: 04/05/2021 5/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Family Recovery Center
Service Type:
Program Name:
Certified Capacity:PRU 51813
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10635_Family.pdf
Certificate Number: 220710779
1235 Montauk Highway , , Mastic, New York 11950
Effective: 08/01/2019 7/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Family Recovery Center
Service Type:
Program Name:
Certified Capacity:PRU 50994
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10779_Family.pdf
Certificate Number: 220711602
Suite 300, 3rd Floor, 400 West Main Street, , Riverhead, New York 11901
Effective: 08/01/2019 7/31/2022
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)
Family Recovery Center
Service Type:
Program Name:
Certified Capacity:PRU 52084
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11602_Family.pdf
Certificate Number: 210312229
Suite C, 90 Adams Avenue, , Hauppauge, New York 11788
Effective: 04/13/2020 3/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53494
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12229_Family.pdf
Family Service Society, Inc.
Ms. Harmony Ayers-Friedlander, Executive Director
280 Princeton Avenue Ext., Corning, NY 14830
Provider Number: 396
Administrative Office:
Telephone - (607)-962-3148 Ext 216
Certificate Number: 220111993
Administrative Site at: Corning Area Youth Center, Office #9, 2nd Floor, 79 Flint Avenue, Corning, New York 14830
Effective: 02/01/2020 1/31/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90585
January 31, 2022 Page 80 of 227
Campbell-Savona Elementary School, 1st Floor, Room 150B, 64 East Lamoka Avenue, Savona, NY 14879
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11993_Family.pdf
Farnham, Inc. d/b/a Farnham Family Services
Mr. Eric A. Bresee MS, LMHC, Executive Director
283 West 2nd Street, Oswego, NY 13126
Provider Number: 15660
Administrative Office:
Telephone - (315)-342-4489 Ext 2260
Certificate Number: 220610782
1st Floor, 283 West 2nd Street, , Oswego, New York 13126
Effective: 07/01/2021 6/30/2022
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 687
with Telepractice Designation [with ancillary withdrawal services]
14 Crossroads Drive, Fulton, NY 13069
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10782_Farnha.pdf
Certificate Number: 220411988
1st Floor, 283 West 2nd Street, , Oswego, New York 13126
Effective: 05/29/2020 4/30/2022
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90648
with Telepractice Designation
Central Square High School, 642 South Main Street, Central Square, NY 13036
Other Service Site(s) At:
Burton Ramer Tech Career Center, Room A160, 179 County Route 64, Mexico, NY 13114
Other Service Site(s) At:
Fulton Community School, 129 Curtis Street, Fulton, NY 13069
Other Service Site(s) At:
Frederick Leighton Elementary School, 1 Buccaneer Boulevard, Oswego, NY 13126
Other Service Site(s) At:
Oswego Middle School, 10 Mark Fitzgibbons Drive, Oswego, NY 13126
Other Service Site(s) At:
Kingsford Park School, Data Room, 275 West 5th Street, Oswego, NY 13126
Other Service Site(s) At:
John C. Birdlebough High School, 552 Main Street, Phoenix, NY 13135
Other Service Site(s) At:
Volney Elementary School, 1st Floor, Counseling, 2592 State Route 3, Fulton, NY 13069
Other Service Site(s) At:
Emerson J. Dillon Middle School (Phoenix), 116 Volney Street, Phoenix, NY 13135
Other Service Site(s) At:
Hannibal High School, 928 Cayuga Street, Hannibal, NY 13074
Other Service Site(s) At:
Altmar-Parish-Williamstown High School, 639 County Route 22, Parish, NY 13131
Other Service Site(s) At:
CARE Program, SUNY Oswego, Sheldon Hall, Lower Level, Room 101, 7060 State Route 104, Oswego, NY 13126
Other Service Site(s) At:
January 31, 2022 Page 81 of 227
Pulaksi Elementary School, 1st Floor, Counseling, 2 Hinman Road, Pulaski, NY 13142
Other Service Site(s) At:
Michael A. Maroun Elementary School, 1st Floor, Room 128, 11 Elm Street, Phoenix, NY 13135
Other Service Site(s) At:
Minetto Elementary School, All Purpose Room, 2411 County Route 8, Oswego, NY 13126
Other Service Site(s) At:
Sandy Creek High School, PO Box 248, Sandy Creek, NY 13145
Other Service Site(s) At:
Bridges to Success, 1st Floor, Rooms 101 & 102, 80 Dutch Ridge Road, Oswego, NY 13126
Other Service Site(s) At:
Mexico Middle School, 16 Fravor Road, Mexico, NY 13114
Other Service Site(s) At:
Central Square Middle School, Guidance Office & 008C, 248 US Route 11, Central Square, NY 13036
Other Service Site(s) At:
G. Ray Bodley High School (Fulton), 6 William Gillard Drive, Fulton, NY 13069
Other Service Site(s) At:
Mexico High School, 3338 Main Street, Mexico, NY 13114
Other Service Site(s) At:
Pulaski Middle School, 4624 Salina Street, Pulaski, NY 13142
Other Service Site(s) At:
Pulaski High School, 4624 Salina Street, Pulaski, NY 13142
Other Service Site(s) At:
Fitzhugh Park Elementary School, 195 E. Bridge Street, Oswego, NY 13126
Other Service Site(s) At:
Charles E. Riley Elementary School, 269 East 8th Street, Oswego, NY 13126
Other Service Site(s) At:
Fulton School District 4th Street School, Guidance Office, Education Center, 167 South 4th Street, Fulton, NY 13069
Other Service Site(s) At:
Oswego High School, 2 Buccaneer Boulevard, Oswego, NY 13126
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11988_Farnha.pdf
Certificate Number: 210812115
1st Floor, 283 West Second Street, , Oswego, New York 13126
Effective: 01/24/2019 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Farnham Family Services OTP
100Service Type:
Program Name:
Certified Capacity:PRU 53016
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12115_Farnha.pdf
Certificate Number: 220612269
1st Floor, 111 Hamilton Street, , Mexico, New York 13114
Effective: 06/23/2021 6/30/2022
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53560
with Telepractice Designation
January 31, 2022 Page 82 of 227
61 Delano Street, Pulaski, NY 13142
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12269_Farnha.pdf
Federation of Organizations for the New York State Mentally Disabled, Inc.
Ms. Barbara Faron, CEO
1 Farmingdale Avenue, West Babylon, NY 11704
Provider Number: 16290
Administrative Office:
Telephone - (631)-559-5355
Certificate Number: 211212230
1375 Akron Street, , Copiague, New York 11726
Effective: 01/04/2021 12/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53500
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12230_Federa.pdf
Finger Lakes Area Counseling and Recovery Agency, Inc.
Ms. Jennifer Carlson, CEO
5th Floor, 28 East Main Street, Clifton Springs, NY 14432
Provider Number: 39040
Administrative Office:
Telephone - (315)-462-9148
Certificate Number: 181210179
5th Floor, 28 East Main Street, Clifton Springs, New York 14432
Effective: 12/03/2018 12/31/2018
Program Location:
Amendment Anticipated Recert Review:
Supportive Living (819) 54Service Type:
Program Name:
Certified Capacity:PRU 51066
with Telepractice Designation
Supportive Living (819) 8Service Type:
Program Name:
Certified Capacity:PRU 51794
with Telepractice Designation
Supportive Living (819) 11Service Type:
Program Name:
Certified Capacity:PRU 52699
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10179_Finger.pdf
Certificate Number: 210910784
1st and 2nd Floors, 246 Castle Street, , Geneva, New York 14456
Effective: 10/06/2020 9/30/2021
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51067
[with ancillary withdrawal services] with Telepractice Designation
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10784_Finger.pdf
January 31, 2022 Page 83 of 227
Certificate Number: 210710785
3rd Floor, 28 East Main Street, Clifton Springs, New York 14432
Effective: 05/06/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50072
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10785_Finger.pdf
Certificate Number: 211010786
310 West Union Street, Newark, New York 14513
Effective: 11/01/2019 10/31/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
FLACRA Addictions Clinic
0Service Type:
Program Name:
Certified Capacity:PRU 50074
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10786_Finger.pdf
Certificate Number: 200911569
1 Keuka Business Park, 3rd Floor, 2466 Route 54A, , Penn Yan, New York 14527
Effective: 05/06/2020 9/30/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Penn Yan Outpatient Clinic
Service Type:
Program Name:
Certified Capacity:PRU 51986
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11569_Finger.pdf
Certificate Number: 221211570
Suite 3, 1st Floor, 106 South Perry Street, Watkins Glen, New York 14891
Effective: 05/06/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
FLACRA Addictions Clinic
0Service Type:
Program Name:
Certified Capacity:PRU 51717
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11570_Finger.pdf
Certificate Number: 220411816
1386 Hathaway Drive, , Farmington, New York 14425
Effective: 05/06/2020 4/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52776
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11816_Finger.pdf
Certificate Number: 201111824
Building 14, 2650 East Street, , Canandaigua, New York 14424
Effective: 10/28/2019 11/30/2020
Program Location:
Amendment Anticipated Recert Review:
Community Residential (819) 15Service Type:
Program Name:
Certified Capacity:PRU 52685
with Telepractice Designation
January 31, 2022 Page 84 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11824_Finger.pdf
Certificate Number: 221111948
4th Floor, 28 East Main Street, , Clifton Springs, New York 14432
Effective: 12/01/2019 11/30/2022
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 11Service Type:
Program Name:
Certified Capacity:PRU 52926
with Telepractice Designation - [up to 11 beds may be used for the provision of residential services (stabilization)]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11948_Finger.pdf
Certificate Number: 210112132
Otte Hall, 621 Church Street, Newark, New York 14513
Effective: 02/01/2020 1/31/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Residential Services (820) 23Service Type:
Program Name:
Certified Capacity:PRU 53226
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12132_Finger.pdf
Certificate Number: 190312133
2nd Floor, 28 East Main Street, Clifton Springs, New York 14432
Effective: 12/03/2018 3/31/2019
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820) 19Service Type:
Program Name:
Certified Capacity:PRU 53227
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12133_Finger.pdf
Certificate Number: 200512173
4th Floor, 28 East Main Street, , Clifton Springs, New York 14432
Effective: 06/10/2019 5/31/2020
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Addictions Crisis Center
12Service Type:
Program Name:
Certified Capacity:PRU 53308
with Telepractice Designation [up to 12 beds may be used for the provision of medically supervised inpatient withdrawal & stabilization services]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12173_Finger.pdf
First Steps to Recovery, Inc.
Ms. Allyne Spinner LCSW, Executive Director
Ground Floor, 312 West 47th Street, New York, NY 10036
Provider Number: 2090
Administrative Office:
Telephone - (212)-307-5280
Certificate Number: 200510787
Ground Floor, 310-312 West 47th Street, New York, New York 10036
Effective: 11/01/2019 5/31/2020
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6272
with Telepractice Designation
January 31, 2022 Page 85 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10787_FirstS.pdf
Certificate Number: 200411261
1st Floor, 2990 Brighton 12th Street, Brooklyn, New York 11235
Effective: 11/01/2019 4/30/2020
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7334
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11261_FirstS.pdf
Five Towns Community Center, Inc.
Mr. K. Brent Hill, Executive Director
270 Lawrence Avenue, Lawrence, NY 11559
Provider Number: 33240
Administrative Office:
Telephone - (516)-239-6244 Ext 234
Certificate Number: 220811513
Rooms S4, S10-S17, S19, S25, and S31, 2nd Floor, 270 Lawrence Avenue, , Lawrence, New York 11559
Effective: 09/22/2020 8/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 765
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11513_FiveTo.pdf
Flushing Hospital and Medical Center
Mr. Bruce J. Flanz, President & CEO
4500 Parsons Boulevard, Flushing, NY 11355
Provider Number: 82070
Administrative Office:
Telephone - (718)-670-5918
Certificate Number: 221110246
4500 Parsons Boulevard, , Flushing, New York 11355
Effective: 02/08/2021 11/30/2022
Program Location:
Amendment Anticipated Recert Review:
Medically Managed Withdrawal & Stabilization Services (816.6) 30Service Type:
Program Name:
Certified Capacity:PRU 51644
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10246_Flushi.pdf
Certificate Number: 221010788
4500 Parsons Boulevard, , Flushing, New York 11355
Effective: 01/13/2021 10/31/2022
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51827
with Telepractice Designation
Integrated Outpatient Services - PCService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10788_Flushi.pdf
January 31, 2022 Page 86 of 227
Forensic Consultants, Ltd.
Mr. Michael Montgomery, Executive Director
2112 Erie Boulevard E, Syracuse, NY 13224
Provider Number: 16530
Administrative Office:
Telephone - (315)-472-1212
Certificate Number: 210410789
Suite 200, 2112 Erie Boulevard East, Syracuse, New York 13224
Effective: 05/01/2019 4/30/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51472
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10789_Forens.pdf
The Fortune Society, Inc.
Ms. JoAnne Page Esq., CEO & President
29-76 Northern Boulevard, Long Island City, NY 11101
Provider Number: 1523
Administrative Office:
Telephone - (347)-510-3408
Certificate Number: 240611539
29-76 Northern Boulevard, Long Island City, New York 11101
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6287
with Telepractice Designation
1st Floor, 625 West 140th Street, New York, NY 10031
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11539_Fortun.pdf
Freedom Institute, Inc.
Ms. Rachel Russell, Chief Clinical Officer
13th Floor, 515 Madison Avenue, New York, NY 10022
Provider Number: 32106
Administrative Office:
Telephone - (212)-838-0044 Ext 0016
Certificate Number: 231110791
Suite 13B, 13th Floor, 515 Madison Avenue, , New York, New York 10022
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51015
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10791_Freedo.pdf
Friends of Bridge, Inc.
Mr. James Wyler, Executive Director
5-11 Pflug Place, Valley Stream, NY 11580
Provider Number: 139
Administrative Office:
Telephone - (516)-825-4242
Certificate Number: 220111515
5-11 Pflug Place, Valley Stream, New York 11580
Effective: 06/10/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 239
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11515_Friend.pdf
January 31, 2022 Page 87 of 227
From the Ashes, Inc. d/b/a The Kenneth Peters Center for Recovery
Mr. Eric Frieman, Aministrative Director
Suite 122 W, 1st Floor, 6800 Jericho Turnpike, Syosset, NY 11788
Provider Number: 17580
Administrative Office:
Telephone - (914)-907-4753
Certificate Number: 210410793
Suite 122W, 1st Floor, 6800 Jericho Turnpike, Syosset, New York 11791
Effective: 05/28/2020 4/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
The Kenneth Peters Center for Recovery
Service Type:
Program Name:
Certified Capacity:PRU 51619
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10793_Fromth.pdf
Certificate Number: 210411637
1st Floor, 300 Motor Parkway, Hauppauge, New York 11788
Effective: 05/28/2020 4/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
The Kenneth Peters Center for Recovery
Service Type:
Program Name:
Certified Capacity:PRU 52130
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11637_Fromth.pdf
Fulton Friendship House, Inc.
Mr. Thomas Ryan, Executive Director
18 Cayadutta Street, P.O. Box 292, Gloversville, NY 12078
Provider Number: 12190
Administrative Office:
Telephone - (518)-725-1512
Certificate Number: 211210015
Victorian Manor, 1st-3rd Floors, Basement, 8-10 First Avenue, Gloversville, New York 12078
Effective: 01/01/2019 12/31/2021
Program Location:
Renewal Anticipated Recert Review:
Community Residential (819) 20Service Type:
Program Name:
Certified Capacity:PRU 51297
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10015_Fulton.pdf
Garnet Health Medical Center
Mr. Jonathan Schiller, CEO
707 East Main Street, Middletown, NY 10940
Provider Number: 81420
Administrative Office:
Telephone - 845-794-3300 Ext 2100
Certificate Number: 240511335
Suite 135, 75 Crystal Run Road, Middletown, New York 10941
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Horton Family Program for Alcoholism and Chemical Dependency
Service Type:
Program Name:
Certified Capacity:PRU 50932
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11335_Garnet.pdf
Genesee Council on Alcoholism and Substance Abuse, Inc.
Mr. John P. Bennett, Executive Director
430 East Main Street, Batavia, NY 14020
Provider Number: 38100
Administrative Office:
Telephone - (585)-815-1850
January 31, 2022 Page 88 of 227
Certificate Number: 191110168
2nd Floor, 430 East Main Street, Batavia, New York 14020
Effective: 01/01/2018 11/30/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819) 24Service Type:
Program Name:
Certified Capacity:PRU 51739
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10168_Genese.pdf
Certificate Number: 181210169
424 East Main Street, Batavia, New York 14020
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 17Service Type:
Program Name:
Certified Capacity:PRU 51203
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10169_Genese.pdf
Certificate Number: 221010795
430 East Main Street, , Batavia, New York 14020
Effective: 01/03/2022 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Genesee Council Clinic
Service Type:
Program Name:
Certified Capacity:PRU 50546
with Problem Gambling and Telepractice Designations
Opioid Treatment Program (822)
Genesee Council Clinic
150Service Type:
Program Name:
Certified Capacity:PRU 53610
with Problem Gambling and Telepractice Designations
Capacity Lifted
First Baptist Church, 1st Floor, 5 Main Street, LeRoy, NY 14482
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10795_Genese.pdf
Certificate Number: 210810797
1st Floor & Basement, 249 East Avenue & 166 McKinstry Street, Albion, New York 14411
Effective: 05/28/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Genesee Council Clinic
Service Type:
Program Name:
Certified Capacity:PRU 51798
with Problem Gambling and Telepractice Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10797_Genese.pdf
Certificate Number: 230112295
424 E. Main St. , , Batavia, New York 14020
Effective: 01/25/2022 1/31/2023
Program Location:
Establishment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 16Service Type:
Program Name:
Certified Capacity:PRU 53600
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12295_Genese.pdf
Genesis Detox of Brooklyn, LLC
Mr. Samuel Benitez, Chief Executive Officer
449 39th Street, Brooklyn, NY 11232
Provider Number: 49600
Administrative Office:
Telephone - (718)-633-4673 Ext 115
January 31, 2022 Page 89 of 227
Certificate Number: 240912064
449 39th Street, Brooklyn, New York 11232
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 35Service Type:
Program Name:
Certified Capacity:PRU 53059
- with the use of methadone
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12064_Genesi.pdf
Good Samaritan Hospital of Suffern, N.Y.
Mary Leahy M.D., CEO
2nd Floor, 255 Lafayette Avenue, Suffern, NY 10901
Provider Number: 85370
Administrative Office:
Telephone - (845)-368-5303
Certificate Number: 211110297
3rd Floor, 255 Lafayette Avenue, Suffern, New York 10901
Effective: 01/31/2019 11/10/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 6Service Type:
Program Name:
Certified Capacity:PRU 4494
- with the use of methadone
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10297_GoodSa.pdf
Certificate Number: 211111370
3rd Floor, 255 Lafayette Avenue, Suffern, New York 10901
Effective: 01/31/2019 11/10/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818) 11Service Type:
Program Name:
Certified Capacity:PRU 6972
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11370_GoodSa.pdf
Greenwich House, Inc.
Mr. Darren Bloch, Chief Executive Officer
6th Floor, 122 West 27th Street, New York, NY 10001
Provider Number: 50730
Administrative Office:
Telephone - (212)-991-0003 Ext 201
Certificate Number: 211110382
190 Mercer Street, New York, New York 10012
Effective: 10/02/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Greenwich House East
800Service Type:
Program Name:
Certified Capacity:PRU 18
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10382_Greenw.pdf
Certificate Number: 240610801
6th Floor, 122 West 27th Street, New York, New York 10001
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Greenwich House Counseling Center
Service Type:
Program Name:
Certified Capacity:PRU 586
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10801_Greenw.pdf
January 31, 2022 Page 90 of 227
The Guidance Center of Westchester, Inc.
Ms. Amy Gelles, Executive Director
256 Washington Street, Mount Vernon, NY 10553
Provider Number: 23500
Administrative Office:
Telephone - (914)-613-0700 Ext 7074
Certificate Number: 221110359
Room #s 1, 2, & 3 (Lower Level) - Voc. Assistance Project, Group Room (Lower Level) - CD Groups (Relapse/Recovery), Room #219A-Waiting/Receiving Area (Upper Level) - Methadone Dispensing, Group Room (Lower Level) Co-Occur./OMH Groups, 20 Sickles Avenue
Effective: 12/01/2020 11/30/2022
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Opioid Treatment Program (822) 250Service Type:
Program Name:
Certified Capacity:PRU 397
with Telepractice Designation
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10359_Guidan.pdf
Certificate Number: 211111787
3rd and 4th Floors, 256 Washington Street, Mount Vernon, New York 10553
Effective: 12/01/2020 11/30/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)
Mount Vernon Sunrise
Service Type:
Program Name:
Certified Capacity:PRU 52641
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11787_Guidan.pdf
Halfway Houses of Westchester, Inc.
Mr. Aflred Pride, Executive Director
1st Floor, 14 Longview Avenue, White Plains, NY 10605
Provider Number: 34020
Administrative Office:
Telephone - (914)-946-0949
Certificate Number: 181210115
1st & 2nd Floors, Basement,, 14 Longview Avenue, White Plains, New York 10605
Effective: 01/01/2018 12/31/2018
Program Location:
Conditional Certificate Anticipated Recert Review:
Community Residential (819)
Hawthorne House
10Service Type:
Program Name:
Certified Capacity:PRU 50061
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10115_Halfwa.pdf
Hamilton-Madison House, Inc.
Ms. Isabel Ching, Executive Director
2nd Floor, 253 South Street, New York, NY 10002
Provider Number: 50370
Administrative Office:
Telephone - (212)-349-3724 Ext 9321
Certificate Number: 211010804
2nd Floor, 253 South Street, New York, New York 10002
Effective: 10/02/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Asian American Recovery Services
Service Type:
Program Name:
Certified Capacity:PRU 50049
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10804_Hamilt.pdf
January 31, 2022 Page 91 of 227
HANAC, Inc.
Mr. John P. Kaiteris, Chief Operating Officer
27-40 Hoyt Avenue South, Astoria, NY 11102
Provider Number: 16670
Administrative Office:
Telephone - (212)-204-1200 Ext 105
Certificate Number: 210611516
2nd Floor, 31-14 30th Avenue, Astoria, New York 11102
Effective: 08/25/2020 6/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6118
with Telepractice Designation
1st & 2nd Floors, 23-16 30th Avenue, Astoria, NY 11102
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11516_HANACI.pdf
Hands on Health Associates, LLC
Ms. Marcia Allen-Booker, CEO
249 Pennsylvania Avenue, Brooklyn, NY 11207
Provider Number: 48040
Administrative Office:
Telephone - (347)-547-3626
Certificate Number: 221012036
2nd and 3rd Floors, 249 Pennsylvania Avenue, Brooklyn, New York 11207
Effective: 07/03/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52619
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12036_Handso.pdf
Harrison Youth Council, Inc.
Ms. Amanda Ammirati, Executive Director
1st Floor, 84 Calvert Street, Harrison, NY 10528
Provider Number: 27910
Administrative Office:
Telephone - (914)-835-7500
Certificate Number: 211211971
1st Floor, 84 Calvert Street, Harrison, New York 10528
Effective: 07/02/2021 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90663
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11971_Harris.pdf
Hazelden/New York
Ms. Eliana Leve, Director NY Services
12th Floor, 322 8th Avenue, New York, NY 10001
Provider Number: 2141
Administrative Office:
Telephone - (646)-601-7028
Certificate Number: 210811517
12th Floor, 322 8th Avenue, , New York, New York 10001
Effective: 07/03/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6978
with Telepractice Designation
January 31, 2022 Page 92 of 227
283 West Broadway, New York, NY 10013
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11517_Hazeld.pdf
HealthCare Choices NY, Inc.
Ms. Maria Siebel, CEO
6209 16th Avenue, Brooklyn, NY 11204
Provider Number: 49950
Administrative Office:
Telephone - (718)-234-0073
Certificate Number: 230912161
6209 16th Avenue, , Brooklyn, New York 11204
Effective: 06/16/2021 9/30/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53210
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12161_Health.pdf
Heartshare Human Services of New York as Sponsor, St. Vincent's Services, Inc. as Operator
Ms Dawn V. Saffayeh, Executive Director
St. Vincent's Services, Inc. as Operator, 5th Floor, 66 Boerum Place, Brooklyn, NY 11201
Provider Number: 22300
Administrative Office:
Telephone - (718)-422-2302
Certificate Number: 200911020
Basement & 1st Floor, 66 Boerum Place, Brooklyn, New York 11201
Effective: 10/01/2018 9/30/2020
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 7310
with Telepractive Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11020_Hearts.pdf
Helio Health, Inc.
Mr. Jeremy Klemanski, Chief Executive Officer
555 E. Genesee Street, Syracuse, NY 13202
Provider Number: 36090
Administrative Office:
Telephone - (315)-474-5506
Certificate Number: 200811038
1st, 2nd & 3rd Floors, 329 North Salina Street, , Syracuse, New York 13203
Effective: 04/15/2020 8/31/2020
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Meadows Outpatient Services
0Service Type:
Program Name:
Certified Capacity:PRU 50041
with Telepractice and Problem Gambling Designations [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Suite #201, 321 West Onondaga Street , Syracuse, NY 13202
Additional Location(s) At:
Bldg 5, 1st Floor, 960 Salt Springs Road, Syracuse, NY 13224
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11038_HelioH.pdf
January 31, 2022 Page 93 of 227
Certificate Number: 210911408
1st & 2nd Floors, Basement,, 847 James Street, , Syracuse, New York 13203
Effective: 01/01/2021 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Helio Health Inpatient Facility
40Service Type:
Program Name:
Certified Capacity:PRU 50040
- [up to 40 beds may be used for the provision of medically supervised inpatient withdrawal & stabilization services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11408_HelioH.pdf
Certificate Number: 211111455
1st Floor & Lower Level, 847 James Street, , Syracuse, New York 13203
Effective: 01/01/2021 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
Evaluation Center
25Service Type:
Program Name:
Certified Capacity:PRU 51962
- [up to 25 beds may be used for the provision of inpatient rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11455_HelioH.pdf
Certificate Number: 220811707
1st Floor & Annex B, 1350 University Avenue, , Rochester, New York 14607
Effective: 04/30/2021 8/31/2022
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 30Service Type:
Program Name:
Certified Capacity:PRU 52300
with Telepractice Designation - [all of these beds may be used for the provision of inpatient rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11707_HelioH.pdf
Certificate Number: 230912069
Suite 101, 1st Floor, 329 North Salina Street, Syracuse, New York 13203
Effective: 10/01/2020 9/30/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 250Service Type:
Program Name:
Certified Capacity:PRU 53067
with Telepractice Designation [with ancillary withdrawal services for up to 25 patients]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12069_HelioH.pdf
Certificate Number: 220312136
Building 1 - Wings E, F & G, 249 Glenwood Road, , Binghamton, New York 13905
Effective: 07/03/2020 3/31/2022
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 30Service Type:
Program Name:
Certified Capacity:PRU 53211
[up to 20 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12136_HelioH.pdf
January 31, 2022 Page 94 of 227
Certificate Number: 231012174
Suite 100, 1213 Court Street, , Utica, New York 13502
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 250Service Type:
Program Name:
Certified Capacity:PRU 53296
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12174_HelioH.pdf
Certificate Number: 220712192
Harriet May Mills House, 1074 West Genesee Street, , Syracuse, New York 13204
Effective: 08/01/2021 7/31/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
The Women's Halfway House
12Service Type:
Program Name:
Certified Capacity:PRU 53348
with Telepractice Designation [for women]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12192_HelioH.pdf
Certificate Number: 210712193
168 Lincoln Avenue, , Syracuse, New York 13204
Effective: 10/21/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Lincoln House
30Service Type:
Program Name:
Certified Capacity:PRU 53349
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220712194
3606 James Street, , Syracuse, New York 13206
Effective: 08/01/2021 7/31/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
The Men's Halfway House
16Service Type:
Program Name:
Certified Capacity:PRU 53350
with Telepractice Designation [for men]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12194_HelioH.pdf
Certificate Number: 230212203
Building 1 - Wings E, F & G, 249 Glenwood Road, , Binghamton, New York 13905
Effective: 03/01/2021 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Helio Health Binghamton Inpatient Rehabilitation
20Service Type:
Program Name:
Certified Capacity:PRU 53359
[up to 20 of these beds may be used for the provision of Section 816.7 medically supervised inpatient withdrawal & stabilization services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12203_HelioH.pdf
January 31, 2022 Page 95 of 227
Certificate Number: 201212225
1st and 2nd Floor, 4567 Crossroads Park Drive, Liverpool, New York 13088
Effective: 10/21/2020 12/31/2020
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Elements
75Service Type:
Program Name:
Certified Capacity:PRU 53444
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12225_HelioH.pdf
Certificate Number: 211212248
500 Whitesboro Street , , Utica, New York 13502
Effective: 12/17/2021 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53523
with Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12248_HelioH.pdf
Certificate Number: 211212250
Basement, 1st, & 2nd Floo, 500 Whitesboro Street, , Utica, New York 13502
Effective: 01/21/2021 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820) 44Service Type:
Program Name:
Certified Capacity:PRU 53528
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12250_HelioH.pdf
Certificate Number: 220312263
1st Floor & Annex B, 1350 University Avenue, , Rochester, New York 14607
Effective: 04/30/2021 3/31/2022
Program Location:
Establishment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 10Service Type:
Program Name:
Certified Capacity:PRU 53559
with Telepractice Designation - [all of these beds may be used for the provision of medically supervised withdrawal & stabilization services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12263_HelioH.pdf
Certificate Number: 220512268
121-125 Green Street, , Syracuse, New York 13203
Effective: 06/07/2021 5/31/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Green Street Residential Rehabilitation
30Service Type:
Program Name:
Certified Capacity:PRU 53443
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12268_HelioH.pdf
January 31, 2022 Page 96 of 227
Certificate Number: 220712270
Suite 400, 329 North Salina Street, , Syracuse, New York 13203
Effective: 08/01/2021 7/31/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820) 80Service Type:
Program Name:
Certified Capacity:PRU 53565
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Hispanic Counseling Center, Inc.
Ms. Gladys Serrano, Chief Executive Officer
344 Fulton Avenue, Hempstead, NY 11550
Provider Number: 33160
Administrative Office:
Telephone - (516)-538-2613 Ext 227
Certificate Number: 231110806
1st & 2nd Floors, 344 Fulton Avenue, Hempstead, New York 11550
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50972
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10806_Hispan.pdf
HONOR ehg, Inc.
Mr. Christopher Molinelli, Executive Director
Suite 300, 38 Seward Avenue, Middletown, NY 10940
Provider Number: 34210
Administrative Office:
Telephone - (845)-343-7115
Certificate Number: 200212012
Suite 300, 1st Floor, 38 Seward Avenue, Middletown, New York 10940
Effective: 10/01/2019 2/29/2020
Program Location:
Conditional Certificate Anticipated Recert Review:
Residential Services (820) 20Service Type:
Program Name:
Certified Capacity:PRU 53463
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12012_HONORe.pdf
Hope For Youth, Inc.
David J. Hegarty Ph.D., Executive Director
201 Dixon Avenue, Amityville, NY 11701
Provider Number: 16320
Administrative Office:
Telephone - (631)-782-6501 Ext 111
Certificate Number: 230611767
201 Dixon Avenue, Amityville, New York 11701
Effective: 07/01/2021 6/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52608
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11767_HopeFo.pdf
January 31, 2022 Page 97 of 227
Hope House, Inc.
Mr. Kevin M. Connally, Executive Director
573 Livingston Avenue, Albany, NY 12206
Provider Number: 35300
Administrative Office:
Telephone - (518)-482-4673 Ext 216
Certificate Number: 210510809
3rd Floor, 747 Madison Avenue, Albany, New York 12208
Effective: 09/04/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51291
with Telepractice Designation
St. Anne's Institute, 160 North Main Avenue, Albany, NY 12206
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10809_HopeHo.pdf
Certificate Number: 181211303
1st & 2nd Floors, 890 Madison Avenue, , Albany, New York 12208
Effective: 10/15/2018 12/31/2018
Program Location:
Amendment Anticipated Recert Review:
Community Residential (819)
Hope House Women and Children's Program
21Service Type:
Program Name:
Certified Capacity:PRU 51834
and up to 12 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11303_HopeHo.pdf
Certificate Number: 200612198
2 Holland Avenue, , Albany, New York 12209
Effective: 07/01/2019 6/30/2020
Program Location:
Establishment Anticipated Recert Review:
Supportive Living (819)
Hope House Next Step
6Service Type:
Program Name:
Certified Capacity:PRU 53379
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12198_HopeHo.pdf
Certificate Number: 200612199
2 Holland Avenue, , Albany, New York 12209
Effective: 07/01/2019 6/30/2020
Program Location:
Establishment Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Hope House Next Step
20Service Type:
Program Name:
Certified Capacity:PRU 53380
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12199_HopeHo.pdf
Certificate Number: 240512205
261 North Pearl Street, , Albany, New York 12207
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Bette Center
35Service Type:
Program Name:
Certified Capacity:PRU 53446
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12205_HopeHo.pdf
January 31, 2022 Page 98 of 227
Certificate Number: 210112215
577 Livingston Avenue, , Albany, New York 12206
Effective: 02/24/2020 1/31/2021
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Women's Recovery Program
20Service Type:
Program Name:
Certified Capacity:PRU 53471
[for women]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12215_HopeHo.pdf
Certificate Number: 220412256
1724 Fifth Avenue , , Troy, New York 12180
Effective: 05/01/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)
Hope House Outpatient Clinic Troy
Service Type:
Program Name:
Certified Capacity:PRU 53454
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12256_HopeHo.pdf
Certificate Number: 220412257
559-565 Sixth Avenue, , Troy, New York 12182
Effective: 05/01/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Supportive Living (819)
Hope House Troy Supportive Living
17Service Type:
Program Name:
Certified Capacity:PRU 53456
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12257_HopeHo.pdf
Certificate Number: 220412258
106-108 Ninth Street, , Troy, New York 12180
Effective: 05/01/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Community Residential (819)
Hope House Elizabeth House
16Service Type:
Program Name:
Certified Capacity:PRU 53455
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12258_HopeHo.pdf
Certificate Number: 220512273
573 Livingston Avenue, , Albany, New York 12206
Effective: 06/01/2021 5/31/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Men's Recovery Program
20Service Type:
Program Name:
Certified Capacity:PRU 53551
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12273_HopeHo.pdf
Horizon Health Services, Inc.
Ms. Anne D. Constantino, President and Chief Executive Officer
55 Dodge Road, Getzville, NY 14068
Provider Number: 11130
Administrative Office:
Telephone - (716)-831-2700
January 31, 2022 Page 99 of 227
Certificate Number: 220310811
3020 Bailey Avenue, Buffalo, New York 14215
Effective: 04/01/2020 3/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Bailey Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU 50031
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10811_Horizo.pdf
Certificate Number: 230910812
1370 Niagara Falls Boulevard, Tonawanda, New York 14150
Effective: 10/01/2020 9/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Boulevard Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU 50029
with Telepractice Designation
55 Dodge Road , Getzville, NY 14068
Additional Location(s) At:
37 Niagara Street, Tonawanda, NY 14150
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10812_Horizo.pdf
Certificate Number: 230210814
Suite 350, 699 Hertel Avenue, Buffalo, New York 14207
Effective: 03/01/2020 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51197
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10814_Horizo.pdf
Certificate Number: 240310815
77 Broadway Street, Buffalo, New York 14203
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51198
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10815_Horizo.pdf
Certificate Number: 221210821
637 Davison Road, Lockport, New York 14094
Effective: 01/01/2020 12/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Lockport Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU 51804
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10821_Horizo.pdf
January 31, 2022 Page 100 of 227
Certificate Number: 230111662
2400 Pine Avenue, Niagara Falls, New York 14301
Effective: 12/31/2020 1/31/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Pine Avenue Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU 52194
with Telepractice Designation
1st Floor, 6321 Inducon Drive East, Sanborn, NY 14132
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11662_Horizo.pdf
Certificate Number: 230511680
2563 Union Road, , Cheektowaga, New York 14227
Effective: 06/01/2021 5/31/2023
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Union Losson Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU 52214
with Telepractice Designation
Integrated Outpatient Services - MH
Union Losson Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11680_Horizo.pdf
Certificate Number: 240411690
314 Ellicott Street, , Batavia, New York 14020
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Batavia Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU 52225
with Telepractice Designation
Integrated Outpatient Services - MH
Batavia Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11690_Horizo.pdf
Certificate Number: 220911714
6495 Transit Road, East Amherst, New York 14051
Effective: 10/01/2019 9/30/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
East Amherst Family Recovery Center
0Service Type:
Program Name:
Certified Capacity:PRU 52529
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11714_Horizo.pdf
Certificate Number: 220111772
3345 Southwestern Boulevard, , Orchard Park, New York 14127
Effective: 04/25/2019 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52617
with Telepractice Designation
January 31, 2022 Page 101 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11772_Horizo.pdf
Horizon Village, Inc.
Ms. Anne D. Constantino, President /CEO
55 Dodge Rd., Getzville, NY 14068
Provider Number: 25820
Administrative Office:
Telephone - (716)-831-2700
Certificate Number: 220211820
1st Floor, 291 Elm Street, Buffalo, New York 14203
Effective: 07/10/2020 2/28/2022
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
Terrace House
10Service Type:
Program Name:
Certified Capacity:PRU 52730
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11820_Horizo.pdf
Certificate Number: 181212030
6302 Inducon Drive East, Sanborn, New York 14132
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Residential Services (820)
Delta Village
25Service Type:
Program Name:
Certified Capacity:PRU 53487
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12030_Horizo.pdf
Certificate Number: 181212039
6301 Inducon Drive East, Sanborn, New York 14132
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Residential Services (820)
Horizon Village
50Service Type:
Program Name:
Certified Capacity:PRU 53485
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12039_Horizo.pdf
Certificate Number: 181212040
6331 Inducon Drive East, Sanborn, New York 14132
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Residential Services (820)
Freedom Village
25Service Type:
Program Name:
Certified Capacity:PRU 53486
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12040_Horizo.pdf
Certificate Number: 240112044
1st and 2nd Floors, 291 Elm Street, Buffalo, New York 14203
Effective: 02/01/2021 1/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Terrace House
58Service Type:
Program Name:
Certified Capacity:PRU 53484
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
January 31, 2022 Page 102 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12044_Horizo.pdf
Certificate Number: 190912159
6298 Inducon Drive East, Sanborn, New York 14132
Effective: 10/01/2018 9/30/2019
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Aurora Village
25Service Type:
Program Name:
Certified Capacity:PRU 53488
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12159_Horizo.pdf
Hornell Area Concern for Youth, Inc.
Ms. Susan Hooker, Executive Director
76 East Main Street, Hornell, NY 14843
Provider Number: 397
Administrative Office:
Telephone - (607)-324-0808
Certificate Number: 220611989
Room 1, 1st Floor, 76 East Main Street, Hornell, New York 14843
Effective: 07/01/2019 6/30/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90586
Canisteo-Greenwood Central School District, Ground Floor, Rooms 109 & 153, 120 Greenwood Street, Canisteo, NY 14823
Other Service Site(s) At:
Canisteo-Greenwood Central School District, Psych. Room, 1st Floor, Room 178B, 84 Greenwood Street, Canisteo, NY 14823
Other Service Site(s) At:
Hornell High School Main Office, Conference Room 111 &, Guidance Office, Conference Room, 1st Floor, 134 Seneca Street, Hornell, NY 14843
Other Service Site(s) At:
Canisteo Presbyterian Church, 10 South Main Street, Canisteo, NY 14823
Other Service Site(s) At:
Intermediate School, 1st Floor, Nurse's Office, Room 108, 71 Buffalo Street, Hornell, NY 14843
Other Service Site(s) At:
Jasper-Troupsburg High School Main Building, 1st Floor, Room G100C, 3769 North Main Street, Jasper, NY 14855
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11989_Hornel.pdf
Hospitality House T.C., Inc.
Mr Young Do, Executive Director
271 Central Avenue, Albany, NY 12206
Provider Number: 170
Administrative Office:
Telephone - (518)-434-6468 Ext 106
Certificate Number: 211112048
271 Central Avenue, , Albany, New York 12206
Effective: 12/28/2020 11/30/2021
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820) 45Service Type:
Program Name:
Certified Capacity:PRU 53452
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12048_Hospit.pdf
January 31, 2022 Page 103 of 227
Housing Works, Inc. as Sponsor, Bailey House, Inc. as Operator
Mr. Andrew Coamey, Executive Director
2nd Floor, 120 Lawrence Street, Brooklyn, NY 11201
Provider Number: 1738
Administrative Office:
Telephone - (347)-473-7400
Certificate Number: 221211962
The Rand Harlan Center for Housing, Wellness and Community, 3rd Floor, 1751 Park Avenue, New York, New York 10035
Effective: 06/05/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52933
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11962_Housin.pdf
Housing Works, Inc. as Sponsor, Housing Works Health Services III, Inc. d/b/a Housing Works Community Healt
Mr. Charles A. King, Chief Executive Officer
57 Willoughby Street, Brooklyn, NY 11201
Provider Number: 48960
Administrative Office:
Telephone - (347)-473-7407 Ext 7401
Certificate Number: 230911997
Basement & 1st Floor, 2640 Pitkin Avenue, , Brooklyn, New York 11208
Effective: 10/01/2020 9/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52958
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11997_Housin.pdf
Hudson River Healthcare, Inc. d/b/a Sun River Health
Ms. Anne K. Nolon MPH, President and Chief Executive Officer
1037 Main Street, Peekskill, NY 10566
Provider Number: 34370
Administrative Office:
Telephone - (914)-734-8600
Certificate Number: 230110933
Peekskill Area Health Center, Rooms 226 - 234, Basement & 2nd Floor, 1037 Main Street, Peekskill, New York 10566
Effective: 10/06/2020 1/31/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50979
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10933_Hudson.pdf
Certificate Number: 221112171
2400 Linden Boulevard, , Brooklyn, New York 11208
Effective: 10/06/2020 11/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Alpha School 822 Program
Service Type:
Program Name:
Certified Capacity:PRU 53298
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12171_Hudson.pdf
January 31, 2022 Page 104 of 227
Certificate Number: 211212172
6th Floor, 56 Bay Street, , Staten Island, New York 10301
Effective: 10/06/2020 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Bay Street 822 Program
0Service Type:
Program Name:
Certified Capacity:PRU 53300
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12172_Hudson.pdf
Huntington Youth Bureau Youth Development Research Institute, Inc.
Ms. Maria Georgiou, Executive Director
2nd Floor, 423 Park Avenue, Huntington, NY 11743
Provider Number: 172
Administrative Office:
Telephone - (631)-351-3061
Certificate Number: 220811518
3rd Floor, 423 Park Avenue, Huntington, New York 11743
Effective: 07/03/2020 8/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 992
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11518_Huntin.pdf
Huther-Doyle Memorial Institute, Inc.
Ms. Kelly Reed, President/CEO
360 East Avenue, Rochester, NY 14604
Provider Number: 32707
Administrative Office:
Telephone - (585)-325-5100 Ext 3501
Certificate Number: 221110827
1st & 2nd Floors, 360 East Avenue, Rochester, New York 14604
Effective: 12/01/2020 11/30/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Discovery
Service Type:
Program Name:
Certified Capacity:PRU 6013
with Telepractice Designation [with ancillary withdrawal services
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10827_Huther.pdf
Immigrant Social Services, Inc.
Ms. Beatrice Chen, Executive Director
137 Henry Street, New York, NY 10002
Provider Number: 889
Administrative Office:
Telephone - (212)-571-1840 Ext 100
Certificate Number: 230211974
Basement, 1st & 2nd Floor, 137 Henry Street, New York, New York 10002
Effective: 03/01/2021 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90744
P.S. 2, Room 101B, 122 Henry Street, New York, NY 10002
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11974_Immigr.pdf
January 31, 2022 Page 105 of 227
Innovative Health Systems, Inc.
Mr. Abe Hikind, CEO
2nd Floor, 20 Church Street, White Plains, NY 10601
Provider Number: 32417
Administrative Office:
Telephone - (914)-683-8050
Certificate Number: 210610830
2nd Floor, 20 Church Street, White Plains, New York 10601
Effective: 07/03/2020 6/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50978
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52247
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10830_Innova.pdf
Interborough Developmental and Consultation Center, Inc. d/b/a LSA Recovery (IDCC)
Stephen Gersten Psy.D., CEO
1623 Kings Highway, Brooklyn, NY 11229
Provider Number: 15410
Administrative Office:
Telephone - (929)-273-7601 Ext 427
Certificate Number: 211212253
1664 East 14th Street, , Brooklyn, New York 11229
Effective: 01/07/2021 12/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53511
with Telepractice Designation
1117 Eastern Parkway, Brooklyn, NY 11213
Additional Location(s) At:
6th & 7th Floors, 2846 Stillwell Avenue, Brooklyn, NY 11224
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12253_Interb.pdf
Inter-Care LTD.
Mr. Nicholas Lessa, Chief Executive Officer
7 West Cross Street, Hawthorne, NY 10532
Provider Number: 16640
Administrative Office:
Telephone - (914)-437-6800 Ext 212
Certificate Number: 211110833
4th Floor, 51 East 25th Street, , New York, New York 10010
Effective: 09/30/2021 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51154
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10833_InterC.pdf
January 31, 2022 Page 106 of 227
Certificate Number: 211111882
1st Floor, 5-7 West Cross Street, , Hawthorne, New York 10532
Effective: 05/11/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52852
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11882_InterC.pdf
Inwood Community Services, Inc.
Charles Corliss Ph.D., Executive Director
3rd Floor, 651 Academy Street, New York, NY 10034
Provider Number: 31470
Administrative Office:
Telephone - (212)-942-0043 Ext 133
Certificate Number: 220810836
2nd and 3rd Floors, 651 Academy Street, New York, New York 10034
Effective: 09/09/2020 8/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50985
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10836_Inwood.pdf
Ithaca Alpha House Center, Inc. d/b/a Cayuga Addiction Recovery Services
Ms. Jessica Janssen, CEO
334 West State Street, P.O. Box 789, Ithaca, NY 14850
Provider Number: 10930
Administrative Office:
Telephone - (315)-730-4634
Certificate Number: 210212037
6621 Route 227, Trumansburg, New York 14886
Effective: 03/01/2020 2/28/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Residential Services (820) 60Service Type:
Program Name:
Certified Capacity:PRU 53017
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12037_Ithaca.pdf
Certificate Number: 230912202
334 West State Street, , Ithaca, New York 14850
Effective: 11/22/2021 9/30/2023
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 50Service Type:
Program Name:
Certified Capacity:PRU 53341
with Telepractice Designation
Capacity Lifted
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53607
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12202_Ithaca.pdf
January 31, 2022 Page 107 of 227
JCTOD Outreach, Inc. d/b/a Johnson Park Center
RevDr Maria A. Scates D.D., CEO/Founder
26 Johnson Park, P.O. Box 160, Utica, NY 13503
Provider Number: 48430
Administrative Office:
Telephone - (315)-734-9608
Certificate Number: 181211807
19 Johnson Park, Utica, New York 13501
Effective: 01/01/2018 12/31/2018
Program Location:
Conditional Certificate Anticipated Recert Review:
Supportive Living (819) 6Service Type:
Program Name:
Certified Capacity:PRU 52694
and up to 14 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11807_JCTODO.pdf
The Joan and Sanford I. Weill Medical College of Cornell University
Mr. Gerard Ilaria, Executive Director
Department of Public Health Programs Administration, Room 3-305, 25th, 641 Lexington Avenue, New York, NY 10022
Provider Number: 43750
Administrative Office:
Telephone - (212)-746-5917
Certificate Number: 231111059
9th Floor, 56 West 45th Street, New York, New York 10036
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Midtown Center for Treatment and Research
Service Type:
Program Name:
Certified Capacity:PRU 6098
with Telepractice Designation
6th Floor, Room 650, 53 West 23rd Street, New York, NY 10011
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11059_Joanan.pdf
Lafayette Medical Approach, LLC
Mr Robert Degiarde, Executive Director
233-235 Lafayette Street, New York, NY 10012
Provider Number: 45580
Administrative Office:
Telephone - (212)-226-6263
Certificate Number: 230111804
1st & 2nd Floors, 233-235 Lafayette Street, New York, New York 10012
Effective: 09/01/2020 1/31/2023
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 600Service Type:
Program Name:
Certified Capacity:PRU 52692
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11804_Lafaye.pdf
Larchmont-Mamaroneck Narcotics Guidance Council
Mark Levy Ph.D., Executive Director
234 Stanley Avenue, Mamaroneck, NY 10543
Provider Number: 447
Administrative Office:
Telephone - (914)-698-7549
Certificate Number: 240412000
1st Floor, 234 Stanley Avenue, Mamaroneck, New York 10543
Effective: 08/10/2021 4/30/2024
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90588
with Telepractice Designation
January 31, 2022 Page 108 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12000_Larchm.pdf
LaSalle School
Mr. David C. Wallace, Chief Executive Officer
391 Western Avenue, Albany, NY 12203
Provider Number: 12400
Administrative Office:
Telephone - (518)-242-4731 Ext 218
Certificate Number: 240110842
Admin. Building, Burke Hall, Hanner Chapel, Cultural Center, Gym, Cafeteria, & Lobby Conference, 391 Western Avenue, Rooms 101, 204, 205 & 206, Albany, New York 12203
Effective: 02/01/2021 1/31/2024
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 5469
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10842_LaSall.pdf
Certificate Number: 220812276
391 Western Avenue, , Albany, New York 12203
Effective: 09/23/2021 8/31/2022
Program Location:
Establishment Anticipated Recert Review:
Community Psychiatric Support & Treatment (CPST)Service Type:
Program Name:
Certified Capacity:PRU 53590
Other Licensed PractitionersService Type:
Program Name:
Certified Capacity:PRU 53588
Psychosocial Rehabilitation (PSR)Service Type:
Program Name:
Certified Capacity:PRU 53589
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12276_LaSall.pdf
Lesbian and Gay Community Services Center Inc.
Ms. Glennda Testone, Executive Director
208 West 13th Street, New York, NY 10011
Provider Number: 31450
Administrative Office:
Telephone - (212)-620-7310 Ext 419
Certificate Number: 220711628
1st Floor, 208 West 13th Street, New York, New York 10011
Effective: 09/04/2020 7/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Center CARE Recovery
Service Type:
Program Name:
Certified Capacity:PRU 52109
with Telepractice Designation
Outpatient Service (822)
Center CARE Recovery
Service Type:
Program Name:
Certified Capacity:PRU 52950
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11628_Lesbia.pdf
January 31, 2022 Page 109 of 227
Certificate Number: 230211972
Annex, 208 West 13th Street, New York, New York 10011
Effective: 03/01/2020 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90778
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11972_Lesbia.pdf
Lexington Center for Recovery, Inc.
Adrienne Marcus Ph.D., Chief Executive Officer
2875 Route 35, Katonah, NY 10536
Provider Number: 34200
Administrative Office:
Telephone - (914)-666-0191 Ext 1006
Certificate Number: 230710575
24 Smith Avenue, Mount Kisco, New York 10549
Effective: 08/01/2021 7/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Mount Kisco Clinic
Service Type:
Program Name:
Certified Capacity:PRU 50818
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10575_Lexing.pdf
Certificate Number: 210911340
41 Page Park Drive, , Poughkeepsie, New York 12603
Effective: 02/11/2019 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50577
with Telepractice Designation
Outpatient Rehabilitation Service (822)
Page Park Day Rehab. Program
40Service Type:
Program Name:
Certified Capacity:PRU 53580
with Telepractice Designation
Dover High School, 2368 Route 22, Dover Plains, NY 12522
Additional Location(s) At:
3rd Floor, 135 County House Road, Millbrook, NY 12545
Additional Location(s) At:
Suite 2, 7 Dover Village Plaza, Dover Plains, NY 12522
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11340_Lexing.pdf
Certificate Number: 231111341
Summerlin Plaza, Suites 201-204, 942 Route 376, Wappingers Falls, New York 12590
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51777
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11341_Lexing.pdf
January 31, 2022 Page 110 of 227
Certificate Number: 240511461
2nd Floor, 3 Cottage Place, , New Rochelle, New York 10801
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50386
with Telepractice and Problem Gambling Designations
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51940
with Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11461_Lexing.pdf
Certificate Number: 230211477
Suite 200, 41 Page Park Drive, , Poughkeepsie, New York 12603
Effective: 08/04/2020 2/28/2023
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 300Service Type:
Program Name:
Certified Capacity:PRU 391
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11477_Lexing.pdf
Certificate Number: 230211641
Suite 111, 100 Route 59, , Airmont, New York 10952
Effective: 08/09/2021 2/28/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52137
with Telepractice and Problem Gambling Designations
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52140
with Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11641_Lexing.pdf
Certificate Number: 230111727
Samsondale Shopping Plaza, 45 South Route 9W, , West Haverstraw, New York 10993
Effective: 07/03/2020 1/31/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52154
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11727_Lexing.pdf
Certificate Number: 210311755
2nd Floor, 412 Main Street, , Poughkeepsie, New York 12601
Effective: 04/01/2019 3/31/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52586
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11755_Lexing.pdf
January 31, 2022 Page 111 of 227
Certificate Number: 231111794
Suite D, 706 Executive Boulevard, Valley Cottage, New York 10989
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822)
Rockland Medication Assisted Treatment Program
250Service Type:
Program Name:
Certified Capacity:PRU 52646
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11794_Lexing.pdf
Certificate Number: 221011862
3 Corporate Drive, , Peekskill, New York 10566
Effective: 11/01/2019 10/31/2022
Program Location:
Renewal Anticipated Recert Review:
Opioid Full Agonist Treatment Program (822) 235Service Type:
Program Name:
Certified Capacity:PRU 52801
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11862_Lexing.pdf
Certificate Number: 211111883
3 Corporate Drive, , Peekskill, New York 10566
Effective: 09/19/2019 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
LCR Peekskill Clinic
0Service Type:
Program Name:
Certified Capacity:PRU 52800
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11883_Lexing.pdf
Liberty Resources, Inc.
Mr. Carl M. Coyle, Chief Executive Officer
Suite 200, 6723 Towpath Road, East Syracuse, NY 13507
Provider Number: 50660
Administrative Office:
Telephone - (315)-425-1004 Ext 255
Certificate Number: 190710205
239 Broad Street, Oneida, New York 13421
Effective: 04/25/2019 7/31/2019
Program Location:
Amendment Anticipated Recert Review:
Supportive Living (819)
The Next Step Apartment Program
30Service Type:
Program Name:
Certified Capacity:PRU 51601
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10205_Libert.pdf
Certificate Number: 181210206
239 Broad Street, Oneida, New York 13421
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 18Service Type:
Program Name:
Certified Capacity:PRU 51121
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10206_Libert.pdf
January 31, 2022 Page 112 of 227
Certificate Number: 220112206
1045 James Street, , Syracuse, New York 13203
Effective: 02/01/2021 1/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)
Liberty Resources Integrated Health Care
Service Type:
Program Name:
Certified Capacity:PRU 53457
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12206_Libert.pdf
Long Beach Reach, Inc.
Joseph M. Smith Ph.D., Executive Director
Suite 200, 3rd Floor, 2-12 West Park Avenue, Long Beach, NY 11561
Provider Number: 190
Administrative Office:
Telephone - (516)-889-2332
Certificate Number: 220910851
2nd & 3rd Floors, 2-12 West Park Avenue, Long Beach, New York 11561
Effective: 10/01/2020 9/30/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7051
with Telepractice Designation
225 Main Street, Port Washington, NY 11050
Additional Location(s) At:
Suite 106, 340 Dogwood Avenue, Franklin Square, NY 11010
Additional Location(s) At:
2nd Floor, 165 East Park Avenue, Long Beach, NY 11561
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10851_LongBe.pdf
Long Island Center for Recovery, Inc.
Ms. Shawn Hamilton, Chief Executive Officer
320 West Montauk Highway, Hampton Bays, NY 11946
Provider Number: 25850
Administrative Office:
Telephone - (631)-728-3100
Certificate Number: 220710071
320 West Montauk Highway, Hampton Bays, New York 11946
Effective: 08/01/2019 7/31/2022
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 10Service Type:
Program Name:
Certified Capacity:PRU 51759
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10071_LongIs.pdf
Certificate Number: 240411373
320 West Montauk Highway, Hampton Bays, New York 11946
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 40Service Type:
Program Name:
Certified Capacity:PRU 51713
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11373_LongIs.pdf
January 31, 2022 Page 113 of 227
Long Island Consultation Center, Inc.
Ms. Elaine Lederer, Executive Director
Suite 222, 2nd Floor, 91-31 Queens Boulevard, Elmhurst, NY 11373
Provider Number: 16190
Administrative Office:
Telephone - (718)-896-3400 Ext 118
Certificate Number: 240410852
2nd Floor, 91-31 Queens Boulevard, Elmhurst, New York 11373
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50330
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10852_LongIs.pdf
Long Island Treatment Center LLC
Mr. Jesse Reuter, CEO
100 W. Nicholai Street, Hicksville, NY 11801
Provider Number: 51710
Administrative Office:
Telephone - (718)-483-2953
Certificate Number: 220912285
100 W. Nicholai Street, , Hicksville, New York 11801
Effective: 12/21/2021 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Long Island Treatment Center
Service Type:
Program Name:
Certified Capacity:PRU 53561
with Telepractice Designation
Outpatient Rehabilitation Service (822)
Long Island Treatment Center
Service Type:
Program Name:
Certified Capacity:PRU 53591
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12285_LongIs.pdf
The Lower East Side Service Center, Inc.
Ms. Valerie C. Walters, President and Chief Executive Officer
Suite 305, 3rd Floor, 80 Maiden Lane, New York, NY 10038
Provider Number: 23720
Administrative Office:
Telephone - (212)-566-7719
Certificate Number: 211110360
1st, 2nd, 4th and 5th Floors, 46 East Broadway, New York, New York 10002
Effective: 07/10/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 490Service Type:
Program Name:
Certified Capacity:PRU 644
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10360_LowerE.pdf
Certificate Number: 211210361
46 East Broadway (4th & 5th Floors), 62 East Broadway (1st & 2nd Floors), New York, New York 10002
Effective: 01/01/2021 12/31/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Opioid Treatment Program (822)
Clinic III
380Service Type:
Program Name:
Certified Capacity:PRU 646
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10361_LowerE.pdf
January 31, 2022 Page 114 of 227
Certificate Number: 211110362
7 Gouverneur Slip East, New York, New York 10002
Effective: 06/01/2021 11/30/2021
Program Location:
Conditional Certificate Anticipated Recert Review:
Residential Opioid Treatment Program (822) 100Service Type:
Program Name:
Certified Capacity:PRU 311
[for PRU #52063 only] with Telepractice Designation
Residential Opioid Treatment Program (822) 43Service Type:
Program Name:
Certified Capacity:PRU 3096
[for PRU #52063 only] with Telepractice Designation
Residential Opioid Treatment Program (822) 10Service Type:
Program Name:
Certified Capacity:PRU 52063
[for PRU #52063 only] with Telepractice Designation
and up to 8 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10362_LowerE.pdf
Certificate Number: 210511062
4th - 7th Floors, 46 East Broadway, New York, New York 10002
Effective: 07/10/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7294
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11062_LowerE.pdf
LSCA Group, Inc. as Sponsor, BestSelf Behavioral Health, Inc as Operator
Howard K. Hitzel PsyD, President
Suite 300, 255 Delaware Avenue, Buffalo, NY 14202
Provider Number: 50250
Administrative Office:
Telephone - (716)-842-0440 Ext 112
Certificate Number: 210712081
3176 Abbott Road, , Orchard Park, New York 14127
Effective: 08/01/2018 7/31/2021
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)
Abbott Corners Addiction Services
Service Type:
Program Name:
Certified Capacity:PRU 53114
with Telepractice Designation [with ancillary withdrawal services]
2101 Spruce Street, North Collins, NY 14111
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12081_LSCAGr.pdf
Certificate Number: 180512083
1st and 2nd Floors, 951-955 Niagara Street, Buffalo, New York 14213
Effective: 01/01/2018 5/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:OMH Host
Outpatient Service (822)
Lower West Side Addictions Services
Service Type:
Program Name:
Certified Capacity:PRU 53113
with Telepractice Designation [with ancillary withdrawal services]
2nd Floor, 254 Franklin Street, Buffalo, NY 14202
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12083_LSCAGr.pdf
January 31, 2022 Page 115 of 227
Certificate Number: 220912162
3176 Abbott Road, , Orchard Park, New York 14127
Effective: 02/03/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Abbott Corners Addiction Services OTP
99Service Type:
Program Name:
Certified Capacity:PRU 53276
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12162_LSCAGr.pdf
Certificate Number: 210812191
1st & 2nd Floors, 232-262 Hempstead Avenue, , Buffalo, New York 14215
Effective: 09/01/2020 8/31/2021
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
The Lighthouse -Women's Residential Treatment Program
22Service Type:
Program Name:
Certified Capacity:PRU 53458
with Telepractice Designation
and up to 30 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12191_LSCAGr.pdf
Medical Arts Sanitarium, Inc.
Mr. Thomas Puzo, Chief Executive Officer
159-05 Union Turnpike, Fresh Meadows, NY 11366
Provider Number: 81770
Administrative Office:
Telephone - (718)-906-6700 Ext 3103
Certificate Number: 221010239
Rhinebeck Lodge, Building 1, 2nd Floor, 500 Milan Hollow Road, Rhinebeck, New York 12572
Effective: 11/01/2019 10/31/2022
Program Location:
Renewal Anticipated Recert Review:
d/b/a Cornerstone of Rhinebeck
Inpatient Rehabilitation Service ( 818)
Cornerstone of Rhinebeck, NY
93Service Type:
Program Name:
Certified Capacity:PRU 50486
for adults - with the use of methadone [up to 13 of these beds, in Rm 114-117, may be used for the provision of medically supervised inpatient withdrawal & stabilization services, as needed.]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10239_Medica.pdf
Certificate Number: 221010241
2nd Floors, Basement, 1st &, 159-05 Union Turnpike, Fresh Meadows, New York 11366
Effective: 11/24/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
d/b/a Cornerstone of Medical Arts Center
Inpatient Rehabilitation Service ( 818) 60Service Type:
Program Name:
Certified Capacity:PRU 51379
for adults - with the use of methadone [up to 58 of these beds may be used for the provision of medically supervised inpatient withdrawal & stabilization services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10241_Medica.pdf
January 31, 2022 Page 116 of 227
Certificate Number: 221111438
Rhinebeck Lodge, Building 1, Ground Floor, 500 Milan Hollow Road, Rhinebeck, New York 12572
Effective: 12/01/2019 11/1/2022
Program Location:
Renewal Anticipated Recert Review:
d/b/a Cornerstone of Rhinebeck
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
Cornerstone of Rhinebeck, NY
6Service Type:
Program Name:
Certified Capacity:PRU 7163
for adults - with the use of methadone [up to 3 of these beds, in Room #114, may be used for the provision of inpatient rehabilitation services, as needed.]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11438_Medica.pdf
Certificate Number: 221111440
4th Floors, Basement, 3rd &, 159-05 Union Turnpike, Fresh Meadows, New York 11366
Effective: 11/24/2020 11/30/2022
Program Location:
Amendment Anticipated Recert Review:
d/b/a Cornerstone of Medical Arts Center
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 116Service Type:
Program Name:
Certified Capacity:PRU 9
for adults - with the use of methadone [up to 58 of these beds may be used for the provision of inpatient rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11440_Medica.pdf
Mental Health America of Dutchess County, Inc.,
Mr. Andrew O'Grady, CEO
253 Mansion Street, Poughkeepsie, NY 12601
Provider Number: 14020
Administrative Office:
Telephone - (845)-473-2500
Certificate Number: 220812278
Route 376, 2103 New Hackensack Road, , Poughkeepsie, New York 12603
Effective: 09/20/2021 8/31/2022
Program Location:
Establishment Anticipated Recert Review:
Community Residential (819)
Dowling House
12Service Type:
Program Name:
Certified Capacity:PRU 53592
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12278_Mental.pdf
Certificate Number: 220812279
230 Church Street, , Poughkeepsie, New York 12601
Effective: 09/20/2021 8/31/2022
Program Location:
Establishment Anticipated Recert Review:
Community Residential (819)
Bolger House
24Service Type:
Program Name:
Certified Capacity:PRU 53593
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12279_Mental.pdf
Certificate Number: 220812280
24 West Cottage Road, , Poughkeepsie, New York 12601
Effective: 09/20/2021 8/31/2022
Program Location:
Establishment Anticipated Recert Review:
Community Residential (819)
Florence Manor
24Service Type:
Program Name:
Certified Capacity:PRU 53594
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12280_Mental.pdf
January 31, 2022 Page 117 of 227
Certificate Number: 220812281
1st Floor, 51 Cannon Street, , Poughkeepsie, New York 12601
Effective: 09/20/2021 8/31/2022
Program Location:
Establishment Anticipated Recert Review:
Medically Monitored Withdrawal & Stabilization Services (816.9) 12Service Type:
Program Name:
Certified Capacity:PRU 53595
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12281_Mental.pdf
Mental Health Association in Fulton and Montgomery Counties, Inc.
Ms. Janine Dykeman, Executive Director
307-309 Meadow Street, Johnstown, NY 12095
Provider Number: 24020
Administrative Office:
Telephone - (518)-762-5332
Certificate Number: 181211773
26 Phillips Street, Amsterdam, New York 12010
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Lighthouse
12Service Type:
Program Name:
Certified Capacity:PRU 52620
and up to 6 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11773_Mental.pdf
Mental Health Providers of Western Queens, Inc.
James T. McQuade Ph.D., Executive Director
2nd Floor, 40-23 62nd Street, Woodside, NY 11377
Provider Number: 16140
Administrative Office:
Telephone - (718)-898-5085
Certificate Number: 210910867
4th Floor, 62-07 Woodside Avenue, Woodside, New York 11377
Effective: 07/10/2020 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51264
with Telepractice Designation
William Cullen Bryant High School, 48-10 31st Avenue, Long Island City, NY 11103
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10867_Mental.pdf
Certificate Number: 240312041
Suite 2A, 2nd Floor, 37-08 91st Street, Jackson Heights, New York 11372
Effective: 08/10/2021 3/31/2024
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90863
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12041_Mental.pdf
Mental Health Services - Erie County South East Corporation V d/b/a Spectrum Human Services
Mr. Bruce C. Nisbet, Chief Executive Officer
227 Thorn Avenue, P.O. Box 631, Orchard Park, NY 14127
Provider Number: 50240
Administrative Office:
Telephone - (716)-662-2040
January 31, 2022 Page 118 of 227
Certificate Number: 210910870
, New York
Effective: 09/09/2021 9/30/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)
South Buffalo Counseling Center
Service Type:
Program Name:
Certified Capacity:PRU 50394
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10870_Mental.pdf
Certificate Number: 210910871
, New York
Effective: 06/01/2019 9/30/2021
Program Location:
Amendment/Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50393
27 Franklin Street, Springville, NY 14141
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10871_Mental.pdf
Certificate Number: 210911522
1280 Main Street, , Buffalo, New York 14209
Effective: 07/30/2021 9/30/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)
New Alternatives
Service Type:
Program Name:
Certified Capacity:PRU 5119
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11522_Mental.pdf
Certificate Number: 210911751
34 North Main Street, , Warsaw, New York 14569
Effective: 06/01/2019 9/30/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52581
[with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11751_Mental.pdf
Mercy Medical Center
Mr. Peter Scaminaci, President
1000 North Village Avenue, Rockville Centre, NY 11570
Provider Number: 85030
Administrative Office:
Telephone - (516)-705-1100
Certificate Number: 240110608
506 Stewart Avenue, Garden City, New York 11530
Effective: 08/10/2021 1/31/2024
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)
Mercy Hospital Family Counseling Services
Service Type:
Program Name:
Certified Capacity:PRU 50360
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10608_MercyM.pdf
January 31, 2022 Page 119 of 227
Certificate Number: 220212244
95 Pine Street, , Freeport, New York 11520
Effective: 03/01/2021 2/28/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Mercy Hall
22Service Type:
Program Name:
Certified Capacity:PRU 53525
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12244_MercyM.pdf
Certificate Number: 220212245
526 Greengrove Avenue, , Uniondale, New York 11553
Effective: 03/01/2021 2/28/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Recovery House
22Service Type:
Program Name:
Certified Capacity:PRU 53526
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12245_MercyM.pdf
Certificate Number: 220212246
150 Buffalo Avenue, , Freeport, New York 11520
Effective: 03/01/2021 2/28/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
New Hope
30Service Type:
Program Name:
Certified Capacity:PRU 53527
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12246_MercyM.pdf
Metropolitan Center for Mental Health
Mr. Robert Basile, Executive Director
160 West 86th Street, New York, NY 10024
Provider Number: 16130
Administrative Office:
Telephone - (212)-362-8755
Certificate Number: 220111330
Basement, 1090 St. Nicholas Avenue, New York, New York 10033
Effective: 08/25/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Families and Individuals in Recovery (FAIR)
Service Type:
Program Name:
Certified Capacity:PRU 51729
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11330_Metrop.pdf
Metropolitan Community Services, Inc. d/b/a Journeys
Rabbi Sinai Halberstam, CEO
1049 38th Street, Brooklyn, NY 11219
Provider Number: 49320
Administrative Office:
Telephone - (718)-633-5328
Certificate Number: 230511996
1049 38th Street, Brooklyn, New York 11219
Effective: 06/01/2021 5/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52957
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11996_Metrop.pdf
January 31, 2022 Page 120 of 227
Mid-Erie Mental Health Services, Inc. d/b/a Endeavor Health Services
Ms. Elizabeth Mauro, Executive Director
Suite 400, 1st Floor, 1526 Walden Avenue, Cheektowaga, NY 14225
Provider Number: 50230
Administrative Office:
Telephone - (716)-895-6700 Ext 4051
Certificate Number: 220110875
Suite 400, 1526 Walden Avenue, Cheektowaga, New York 14225
Effective: 05/28/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50357
withTelepractice Designation [with ancillary withdrawal services]
Baker Victory Services Residential Treatment Facility-Admin. Bldg., 1st Floor, Conference Room/Counseling Office, 125 Martin Road, Lackawanna, NY 14218
Additional Location(s) At:
463 William Street, Buffalo, NY 14204
Additional Location(s) At:
Gateway-Longview, Inc. - Lynde School, Conference Room and Room 61, 6350 Main Street, Williamsville, NY 14221
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10875_MidEri.pdf
Certificate Number: 220110876
2nd Floor, 1131 Broadway, Buffalo, New York 14212
Effective: 05/28/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6428
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10876_MidEri.pdf
MIH Experience, LTD
Fernando Taveras M.D., Executive Director
1st Floor, 4580 Broadway, New York, NY 10040
Provider Number: 48730
Administrative Office:
Telephone - (212)-928-2020
Certificate Number: 210511982
1st Floor, 4580 Broadway, , New York, New York 10040
Effective: 11/19/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52945
with Telepractice Designation [with ancillary withdrawal]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11982_MIHExp.pdf
The Monsignor Carr Institute
Mr. Dennis Walczyk, Chief Executive Officer
Administrative Offices, 741 Delaware Avenue, Buffalo, NY 14209
Provider Number: 24680
Administrative Office:
Telephone - (716)-218-1400 Ext 244
January 31, 2022 Page 121 of 227
Certificate Number: 220811063
Annex, 1st and 2nd Floors, 76 West Humboldt Parkway, Buffalo, New York 14214
Effective: 09/01/2020 8/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 5595
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11063_Monsig.pdf
Montefiore Health System, Inc. as Sponsor Montefiore Mount Vernon Hospital as Operator
Ms. Jaccel Kouns, Executive Director/V.P. of Clinical Services
Montefiore Mount Vernon Hospital as Operator, Building #111, 12 N 7th Avenue, Mount Vernon, NY 10550
Provider Number: 80000
Administrative Office:
Telephone - (914)-631-6100
Certificate Number: 210911813
3 South Sixth Avenue, Mount Vernon, New York 10550
Effective: 09/09/2020 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 400Service Type:
Program Name:
Certified Capacity:PRU 52719
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11813_Montef.pdf
Montefiore Medical Center
Mr. Juan Martinez LCSW, Executive Director
Executive Suite, 1510 Waters Place, Bronx, NY 10461
Provider Number: 85420
Administrative Office:
Telephone - (718)-409-9450
Certificate Number: 210410454
1st & 2nd Floors, 2058 Jerome Avenue, Bronx, New York 10453
Effective: 08/03/2020 4/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 700Service Type:
Program Name:
Certified Capacity:PRU 420
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10454_Montef.pdf
Certificate Number: 231210455
1st Floor, 3550 Jerome Avenue, Bronx, New York 10467
Effective: 01/01/2021 12/31/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 350Service Type:
Program Name:
Certified Capacity:PRU 327
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10455_Montef.pdf
Certificate Number: 240711462
3rd Floor, 2058 Jerome Avenue, Bronx, New York 10453
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51981
with Telepractice Designation
January 31, 2022 Page 122 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11462_Montef.pdf
Certificate Number: 221011677
1st & 2nd Floors, 4401 Bronx Boulevard, Bronx, New York 10470
Effective: 08/05/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Wakefield Recovery Center
Service Type:
Program Name:
Certified Capacity:PRU 52212
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11677_Montef.pdf
Certificate Number: 210911871
804 East 138th Street, , Bronx, New York 10454
Effective: 08/03/2020 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 1080Service Type:
Program Name:
Certified Capacity:PRU 52790
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11871_Montef.pdf
Certificate Number: 190211872
1510 Waters Place, Bronx, New York 10461
Effective: 01/01/2018 2/28/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Medically Supervised Outpatient Withdrawal & Stabilization (816.8)
Outpatient Withdrawal
15Service Type:
Program Name:
Certified Capacity:PRU 52788
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11872_Montef.pdf
Certificate Number: 231111873
1510 Waters Place, Bronx, New York 10461
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822)
Wellness Center at Waters Place
995Service Type:
Program Name:
Certified Capacity:PRU 52786
with Telepractice Designation
Capacity Lifted
Opioid Medical Maintenance (822)
Wellness Center at Waters Place
Service Type:
Program Name:
Certified Capacity:PRU 52789
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11873_Montef.pdf
Certificate Number: 221211874
Track Level, 260 East 161st Street, Bronx, New York 10451
Effective: 08/05/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Wellness Center at Melrose
950Service Type:
Program Name:
Certified Capacity:PRU 52791
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11874_Montef.pdf
January 31, 2022 Page 123 of 227
Certificate Number: 240611875
1510 Waters Place, Bronx, New York 10461
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Next Steps North
Service Type:
Program Name:
Certified Capacity:PRU 52787
with Telepractice Designation
Outpatient Service (822)
Next Steps North
Service Type:
Program Name:
Certified Capacity:PRU 52915
with Telepractice Designation
1200 Waters Place, Bronx, NY 10461
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11875_Montef.pdf
Certificate Number: 211211876
S-Level, 260 East 161st Street, , Bronx, New York 10451
Effective: 08/05/2020 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Next Steps South
Service Type:
Program Name:
Certified Capacity:PRU 52792
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11876_Montef.pdf
Montefiore Nyack Hospital
Mark Geller M.D., President & CEO
160 North Midland Avenue, Nyack, NY 10960
Provider Number: 83100
Administrative Office:
Telephone - (845)-348-2110
Certificate Number: 190110257
Building B, 3rd Floor, 160 North Midland Avenue, Nyack, New York 10960
Effective: 02/05/2018 1/31/2019
Program Location:
Establishment Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 8Service Type:
Program Name:
Certified Capacity:PRU 51030
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10257_Montef.pdf
Certificate Number: 220111065
The Hub, 312 Route 59, , Central Nyack, New York 10960
Effective: 07/02/2021 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51650
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11065_Montef.pdf
Certificate Number: 190111415
Building B, 3rd Floor, 160 North Midland Avenue, Nyack, New York 10960
Effective: 02/05/2018 1/31/2019
Program Location:
Establishment Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
The Recovery Center
20Service Type:
Program Name:
Certified Capacity:PRU 51031
with Telepractice Designation
January 31, 2022 Page 124 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11415_Montef.pdf
Mount Sinai Hospitals Group, Inc. as Sponsor, Beth Israel Medical Center as Operator
Dr Jeremy Boal M.D., President
2 Dazian, First Ave. & 16th Street, New York, NY 10003
Provider Number: 83040
Administrative Office:
Telephone - (212)-420-2520
Certificate Number: 200712092
1st and 2nd Floors, 26 Avenue A, New York, New York 10009
Effective: 06/05/2020 7/31/2020
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
MMTP Avenue A Clinic
400Service Type:
Program Name:
Certified Capacity:PRU 53126
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12093_MountS.pdf
Certificate Number: 200712094
1st and 2nd Floors, 109-11 Delancey Street, New York, New York 10002
Effective: 06/05/2020 7/31/2020
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Gouverneur Clinic
450Service Type:
Program Name:
Certified Capacity:PRU 53125
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12094_MountS.pdf
Certificate Number: 210712096
2nd Floor, 25 12th Street, Brooklyn, New York 11215
Effective: 06/05/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Vincent P. Dole Clinic
600Service Type:
Program Name:
Certified Capacity:PRU 53131
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12096_MountS.pdf
Certificate Number: 200712097
Bernstein Pavilion, 6th Floor, 1-9 Nathan D. Perlman Place, New York, New York 10003
Effective: 08/01/2018 7/31/2020
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 20Service Type:
Program Name:
Certified Capacity:PRU 53139
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12097_MountS.pdf
Certificate Number: 200712098
4th Floor, 103 East 125th Street, New York, New York 10035
Effective: 06/05/2020 7/31/2020
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Harlem No. 2
600Service Type:
Program Name:
Certified Capacity:PRU 53129
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12098_MountS.pdf
January 31, 2022 Page 125 of 227
Certificate Number: 210712099
2nd Floor, 103 East 125th Street, New York, New York 10035
Effective: 06/05/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Harlem No. 6/7
450Service Type:
Program Name:
Certified Capacity:PRU 53135
with Telepractice Designation
3rd Floor, 103 East 125th Street, New York, NY 10035
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12099_MountS.pdf
Certificate Number: 210712100
Bernstein Pavilion, 6th Floor, 1-9 Nathan D. Perlman Place, New York, New York 10003
Effective: 06/22/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53137
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53140
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12100_MountS.pdf
Certificate Number: 231212103
Bernstein Pavilion, 3rd Floor, 10 Nathan D. Perlman Place, New York, New York 10003
Effective: 02/18/2021 12/5/2023
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
Stuyvesant Square Chemical Dependency Treatment Program
30Service Type:
Program Name:
Certified Capacity:PRU 53136
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12103_MountS.pdf
Certificate Number: 210712104
6th Floor, 140 West 125th Street, New York, New York 10027
Effective: 06/05/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Clinic 8
800Service Type:
Program Name:
Certified Capacity:PRU 53130
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12104_MountS.pdf
Certificate Number: 210712105
8th Floor, 103 East 125th Street, New York, New York 10035
Effective: 06/05/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Clinic 1
800Service Type:
Program Name:
Certified Capacity:PRU 53128
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12105_MountS.pdf
January 31, 2022 Page 126 of 227
Certificate Number: 231212106
Bernstein Pavilion, 5th Floor, 1-9 Nathan D. Perlman Place, Pharmacy located on 16th Street and 1st Avenue, , New York, New York 10003
Effective: 02/18/2021 12/5/2023
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 31Service Type:
Program Name:
Certified Capacity:PRU 53138
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12106_MountS.pdf
Mount Sinai Hospitals Group, Inc. as Sponsor, The St. Luke's-Roosevelt Hospital Center, d/b/a Mount Sinai Mor
Mr Arthur Gianelli, CEO Mount Sinai St. Luke's Hospital
1111 Amsterdam Avenue, New York, NY 10025
Provider Number: 87090
Administrative Office:
Telephone - (212)-523-4000
Certificate Number: 240712107
Winston Building , 9th Floor, 1000 Tenth Avenue, , New York, New York 10019
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53143
with Telepractice Designation
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53144
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53148
with Telepractice Designation
2nd Floor, 411 West 114th Street, New York, NY 10025
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12107_MountS.pdf
Certificate Number: 220412109
306 West 102nd Street, New York, New York 10025
Effective: 09/01/2020 4/30/2022
Program Location:
Amendment Anticipated Recert Review:
Community Residential (819)
St. Luke's Roosevelt Hospital Halfway House
24Service Type:
Program Name:
Certified Capacity:PRU 53146
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12109_MountS.pdf
Certificate Number: 210712110
Winston Building, 8th Floor, 1000 Tenth Avenue, , New York, New York 10019
Effective: 09/01/2020 7/14/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 15Service Type:
Program Name:
Certified Capacity:PRU 53141
with Telepractice Designation [with the use of methadone] [up to 15 beds may be used for the provision of inpatient rehabilitation service as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12110_MountS.pdf
January 31, 2022 Page 127 of 227
Certificate Number: 210712111
Winston Building, 8th Floor, 1000 Tenth Avenue, , New York, New York 10019
Effective: 09/01/2020 7/14/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
Mt. Sinai West IP
15Service Type:
Program Name:
Certified Capacity:PRU 53145
with Telepractice Designation [up to 15 beds may be used for the provision of medically managed withdrawal & stabilization services (816.6) as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12111_MountS.pdf
Certificate Number: 210712112
429 West 58th Street, New York, New York 10019
Effective: 09/01/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 350Service Type:
Program Name:
Certified Capacity:PRU 53149
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12112_MountS.pdf
Certificate Number: 220812275
1111 Amsterdam Avenue, , New York, New York 10025
Effective: 09/13/2021 8/31/2022
Program Location:
Establishment Anticipated Recert Review:
Other Licensed PractitionersService Type:
Program Name:
Certified Capacity:PRU 53576
Psychosocial Rehabilitation (PSR)
CARES (Comprehensive Adolescent Rehabilitation and Education Services)
Service Type:
Program Name:
Certified Capacity:PRU 53577
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12275_MountS.pdf
Mountain View Prevention Services, Inc.
Mr. Christopher Paige, Executive Director
7714 Number Three Road, Lowville, NY 13367
Provider Number: 36320
Administrative Office:
Telephone - (315)-376-2321
Certificate Number: 230212035
Administrative Site Only:, First Floor East, 7714 Number Three Road, Lowville, New York 13367
Effective: 03/01/2021 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90693
Beaver River Central School, Office, 1st Floor, Adjacent to Room 152, 9508 Artz Road, Beaver Falls, NY 13305
Other Service Site(s) At:
Lowville Academy & Central School, 3rd Floor, Room Adjacent to Science Lab, 7668 North State Street, Lowville, NY 13367
Other Service Site(s) At:
South Lewis Central School, 2nd Floor, Room 209, 4264 East Road, Turin, NY 13473
Other Service Site(s) At:
Copenhagen Central School, 1st Floor, Room 73A, 3020 Mechanic Street, Copenhagen, NY 13620
Other Service Site(s) At:
Harrisville Central School, Room A115, 14357 Pirate Lane, Harrisville, NY 13648
Other Service Site(s) At:
January 31, 2022 Page 128 of 227
Adirondack Central School, 8181 State Route 294, Boonville, NY 13309
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12035_Mounta.pdf
Mountainside NYC LLC
Ms. Alexandra Helfer LMHC, Executive Director
Suite 1601, 2nd Floor, 347 West 36th Street, New York, NY 10018
Provider Number: 50170
Administrative Office:
Telephone - (860)-824-1397 Ext 165
Certificate Number: 210512149
2nd Floor, 480 Bedford Road, Chappaqua, New York 10514
Effective: 05/28/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:
d/b/a Mountainside Chappaqua
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53240
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12149_Mounta.pdf
Certificate Number: 231212195
2nd Floor, 141 East Main Street, , Huntington, New York 11743
Effective: 01/01/2021 12/31/2023
Program Location:
Renewal Anticipated Recert Review:
d/b/a Mountainside Huntington
Outpatient Service (822)
Mountainside Huntington Outpatient
Service Type:
Program Name:
Certified Capacity:PRU 53352
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12195_Mounta.pdf
Nassau Alternative Advocacy Program, Inc.
Mr. Timothy Andrews, Executive Director
Suite 102, 151 Herricks Road, Garden City Park, NY 11040
Provider Number: 41400
Administrative Office:
Telephone - (516)-741-3111
Certificate Number: 201211269
Suite 102, 151 Herricks Road, Garden City Park, New York 11040
Effective: 05/29/2020 12/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51819
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11269_Nassau.pdf
Nassau County Office of Mental Health, Chemical Dependency and Developmental Disabilities Services
Ms. Omayra Perez, Director
Suite 200, 60 Charles Lindbergh Boulevard, Uniondale, NY 11553
Provider Number: 40150
Administrative Office:
Telephone -
January 31, 2022 Page 129 of 227
Certificate Number: 210210368
Nassau County Medical Center, Building K, 2nd Floors, Basement, 1st &, 2201 Hempstead Turnpike, East Meadow, New York 11554
Effective: 07/10/2020 2/28/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 650Service Type:
Program Name:
Certified Capacity:PRU 52127
with Telepractice Designation
Opioid Medical Maintenance (822)Service Type:
Program Name:
Certified Capacity:PRU 52128
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10368_Nassau.pdf
Nassau Health Care Corporation d/b/a Nassau University Medical Hospital
Mr. Anthony Boutin, Chief Executive Officer
Building G, 2201 Hempstead Turnpike, East Meadow, NY 11554
Provider Number: 85020
Administrative Office:
Telephone - 516-572-8730
Certificate Number: 210610273
10th Floor, 2201 Hempstead Turnpike, East Meadow, New York 11554
Effective: 07/12/2018 6/9/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 20Service Type:
Program Name:
Certified Capacity:PRU 50296
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10273_Nassau.pdf
Certificate Number: 210611615
10th Floor, 2201 Hempstead Turnpike, East Meadow, New York 11554
Effective: 07/12/2018 6/9/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818) 30Service Type:
Program Name:
Certified Capacity:PRU 52094
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11615_Nassau.pdf
National Society for Hebrew Day Schools
Mr. Martin Wangrofsky, Executive Director
Suite 203, 813 Quentin Road, Brooklyn, NY 11223
Provider Number: 796
Administrative Office:
Telephone - (718)-787-4412
January 31, 2022 Page 130 of 227
Certificate Number: 210211977
Suite 203, 813 Quentin Road, Brooklyn, New York 11223
Effective: 12/07/2020 2/28/2021
Program Location:
Amendment Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90739
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90740
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90741
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90742
with Telepractice Designation
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90743
with Telepractice Designation
Bet Yaakov Orot Sarah, Room 303, 1125 Avenue N, Brooklyn, NY 11230
Other Service Site(s) At:
Bnos Yaakov of Pupa, 1st Floor, Guidance Office, 1402 40th Street, Brooklyn, NY 11218
Other Service Site(s) At:
Ezra Academy, 5th Floor, Conference Room, 119-45 Union Turnpike, Forest Hills, NY 11375
Other Service Site(s) At:
Hebrew Academy of Nassau County, 2nd Floor, Conference Room, 609 Hempstead Avenue, West Hempstead, NY 11552
Other Service Site(s) At:
Rabbi Samson Raphael Hirsch School, 1st Floor, 85-93 Bennett Avenue, Brooklyn, NY 10033
Other Service Site(s) At:
Jewish Foundation School, 1st Floor, Counseling Room, 400 Caswell Ave., Staten Island, NY 10314
Other Service Site(s) At:
Ahi Ezer Yeshiva, 2344 Ocean Parkway, Brooklyn, NY 11235
Other Service Site(s) At:
United Lubavitcher Yeshiva, 2nd Floor, Guidance Office, 841 Ocean Parkway, Brooklyn, NY 11230
Other Service Site(s) At:
Beth Rivka Elementary School, 1st Floor, Conference Room, 470 Lefferts Avenue, Brooklyn, NY 11225
Other Service Site(s) At:
Rabbi Jacob Joseph School, 2nd Floor, Room #205, 3495 Richmond Road, Staten Island, NY 10306
Other Service Site(s) At:
Shulamith School for Girls, 2nd Floor, Guidance Office, 1277 East 14th Street, Brooklyn, NY 11230
Other Service Site(s) At:
Hebrew Academy of Five Towns and Rockaway, 1st Floor, Guidance Office, 33 Washington Avenue, Lawrence, NY 11559
Other Service Site(s) At:
January 31, 2022 Page 131 of 227
The Pathways Study Center, Ground Floor, 1305 Coney Island Avenue, Brooklyn, NY 11230
Other Service Site(s) At:
Bnow Yisroel School for Girls, 1629 E. 15th Street, Brooklyn, NY 11229
Other Service Site(s) At:
Yeshiva Ktana of Manhattan, 1st Floor, Guidance Office, 348 West 89th Street, New York, NY 10024
Other Service Site(s) At:
Yeshiva Ahavas Torah, 2961 Nostrand Avenue, Brooklyn, NY 11229
Other Service Site(s) At:
Tomer Devora School for Girls, Tutoring Room B, 4500 9th Avenue, Brooklyn, NY 11220
Other Service Site(s) At:
Yeshiva Toras Emes Kamenitz, 4th Floor, Library, 1904 Avenue N, Brooklyn, NY 11230
Other Service Site(s) At:
Bais Chaya Mushka, 1505 Carroll Street, Brooklyn, NY 11213
Other Service Site(s) At:
Yeshiva Chasen Sofer Elementary School, 1st Floor, Guidance Office, 1876 50th Street, Brooklyn, NY 11204
Other Service Site(s) At:
Beth Jacob of Boro Park, Basement, 1372 46th Street, Brooklyn, NY 11219
Other Service Site(s) At:
Yeshiva of Brooklyn, 1st Floor, Guidance Office, 1470 Ocean Parkway, Brooklyn, NY 11230
Other Service Site(s) At:
Yeshiva Sha'arei Zion, 75-24 Grand Central Parkway, Forest Hills, NY 11375
Other Service Site(s) At:
Yeshiva Ketana of Queens, 78-15 Parsons Boulevard, Flushing, NY 11366
Other Service Site(s) At:
Bais Yaakov Academy, 1213 Elm Avenue, Brooklyn, NY 11230
Other Service Site(s) At:
Bais Yaakov D'Chassidei Gur, 1st Floor, Social Worker's Office, 1975 51st Street, Brooklyn, NY 11204
Other Service Site(s) At:
Yeshiva & Mesivta Torah Temimah, Room 401, 555 Ocean Parkway, Brooklyn, NY 11218
Other Service Site(s) At:
Prospect Park Elementary School, 1st Floor, Guidance Office, 1784 East 17th Street, Brooklyn, NY 11229
Other Service Site(s) At:
Mesivta Chasan Sofer High School, 1st Floor, Guidance Office, 5001 19th Avenue, Brooklyn, NY 11204
Other Service Site(s) At:
Masores Bais Yaakov, 1st Floor, Guidance Office, 1395 Ocean Avenue, Brooklyn, NY 11230
Other Service Site(s) At:
Yeshiva Darchei Torah, 257 Beach 17th Street, Far Rockaway, NY 11691
Other Service Site(s) At:
Mirrer Yeshiva High School, 1st Floor, Guidance Office, 1795 Ocean Parkway, Brooklyn, NY 11223
Other Service Site(s) At:
Hebrew Academy of Nassau County, 1st Floor, Guidance Office, 25 Country Drive, Plainview, NY 11803
Other Service Site(s) At:
Torah Academy for Girls, Room 308, 444 Beach 6th Street, Far Rockaway, NY 11691
Other Service Site(s) At:
January 31, 2022 Page 132 of 227
Yeshiva and Mesivta Torah Vodaath, 4th Floor, Guidance Office, 425 East 9th Street, Brooklyn, NY 11218
Other Service Site(s) At:
Beth Jacob Parochial School of the East Side, 142 Broome Street, New York, NY 10002
Other Service Site(s) At:
Mesivtha Tifereth Jerusalem, 1st Floor, Guidance Room, 145 East Broadway, New York, NY 10002
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11977_Nation.pdf
Neighborhood Coalition for Shelter, Inc.
Ms. Ann Shalof, Executive Director
Suite 1301, 50 Broadway, New York, NY 10004
Provider Number: 19920
Administrative Office:
Telephone - (212)-537-5120
Certificate Number: 220811623
Basement, 921-923 Madison Avenue, New York, New York 10021
Effective: 08/31/2020 8/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Chance for Change
Service Type:
Program Name:
Certified Capacity:PRU 52103
with Telepractice Designation
Outpatient Service (822)
Chance for Change
Service Type:
Program Name:
Certified Capacity:PRU 52103
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11623_Neighb.pdf
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11623_Neighb.pdf
Never Alone, Inc.
Mr. Patricia Mauer, President and Chief Executive Officer
20 Crofts Road, Hurley, NY 12443
Provider Number: 19010
Administrative Office:
Telephone - (845)-339-4272 Ext 12
Certificate Number: 220211630
20 Crofts Road, Hurley, New York 12443
Effective: 03/01/2020 2/28/2022
Program Location:
Renewal Anticipated Recert Review:
Residential Rehabilitation Services for Youth (817) 22Service Type:
Program Name:
Certified Capacity:PRU 51240
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11630_NeverA.pdf
New Hope Manor, Inc.
Ms. Sarah Eilbacher, Executive Director
35 Hillside Road, Barryville, NY 12719
Provider Number: 219
Administrative Office:
Telephone - (845)-557-8353
Certificate Number: 231212047
35 Hillside Road, Barryville, New York 12719
Effective: 01/01/2021 12/31/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 53Service Type:
Program Name:
Certified Capacity:PRU 53065
and up to 12 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
January 31, 2022 Page 133 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12047_NewHop.pdf
Certificate Number: 220112068
1st & 2nd Floors, 141 South Avenue, Poughkeepsie, New York 12601
Effective: 02/01/2021 1/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Residential Services (820) 10Service Type:
Program Name:
Certified Capacity:PRU 53064
and up to 3 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12068_NewHop.pdf
The New Horizon Counseling Center, Inc.
Mr. Herrick Lipton, Chief Executive Officer
108-19 Rockaway Boulevard, South Ozone, NY 11420
Provider Number: 15440
Administrative Office:
Telephone - (718)-845-2670
Certificate Number: 240411865
50 West Hawthorne Avenue, Valley Stream, New York 11580
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52804
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11865_NewHor.pdf
The New York and Presbyterian Hospital
Steven J. Corwin M.D., Chief Executive Officer
525 East 68th Street, New York, NY 10065
Provider Number: 81170
Administrative Office:
Telephone - (212)-305-8000
Certificate Number: 230710400
The Helmsley Medical Tower, 1st Floor, 503 East 70th Street, New York, New York 10021
Effective: 07/08/2020 7/7/2023
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822) 200Service Type:
Program Name:
Certified Capacity:PRU 331
with Telepractice Designation
Opioid Medical Maintenance (822)Service Type:
Program Name:
Certified Capacity:PRU 52205
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10400_NewYor.pdf
Certificate Number: 200511414
8 North Unit, 7-8-8A, 2nd Floor, 21 Bloomingdale Road, White Plains, New York 10605
Effective: 01/01/2018 5/20/2020
Program Location:
Special ReIssue Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818) 14Service Type:
Program Name:
Certified Capacity:PRU 50289
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11414_NewYor.pdf
New York Center For Living, Inc.
Audrey Freshman Ph.D., Executive Director
226 East 52nd Street, New York, NY 10022
Provider Number: 45160
Administrative Office:
Telephone - 212-712-8800
January 31, 2022 Page 134 of 227
Certificate Number: 220712029
224-226 East 52nd Street, New York, New York 10022
Effective: 05/29/2020 7/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53007
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12029_NewYor.pdf
New York City Department of Police
Tremaine Sayles, Executive Director
Medical Division NYPD, 15th Floor, 59-17 Junction Blvd, Corona, NY 11368
Provider Number: 28880
Administrative Office:
Telephone - 718-760-7557
Certificate Number: 190411596
25 Elm Place, , Brooklyn, New York 11201
Effective: 05/01/2018 4/30/2019
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52068
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11596_NewYor.pdf
New York City Health and Hospitals Corporation Bellevue Hospital Center
Mr. William Hicks, Chief Executive Officer
H Building, NB-ME8, 462 First Avenue, New York, NY 10016
Provider Number: 85120
Administrative Office:
Telephone - (212)-562-4132
Certificate Number: 230210442
4th Floor, 462 First Avenue, New York, New York 10016
Effective: 05/01/2021 2/26/2023
Program Location:
Renewal Anticipated Recert Review:Deemed
Opioid Treatment Program (822) 400Service Type:
Program Name:
Certified Capacity:PRU 422
[with ancillary withdrawal services for up to 40 patients] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10442_NewYor.pdf
Certificate Number: 231210618
C & D Building, 2nd Floor, 462 First Avenue, New York, New York 10016
Effective: 03/10/2021 12/31/2023
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51912
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10618_NewYor.pdf
New York City Health and Hospitals Corporation Coney Island Hospital
Ms. Svetlana Lipyanskaya, Chief Executive Officer
Room 2W6, 2601 Ocean Parkway, Brooklyn, NY 11235
Provider Number: 87050
Administrative Office:
Telephone - (718)-616-6020
January 31, 2022 Page 135 of 227
Certificate Number: 240410558
2925 West 19th Street, Brooklyn, New York 11224
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50320
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10558_NewYor.pdf
New York City Health and Hospitals Corporation Cumberland Diagnostic & Treatment Center
Michelle Lewis, Chief Executive Officer
100 North Portland Avenue, Brooklyn, NY 11205
Provider Number: 85450
Administrative Office:
Telephone - 718-260-7895
Certificate Number: 220610578
1st & 2nd Floors, Basement,, 100 North Portland Avenue, Brooklyn, New York 11205
Effective: 07/01/2021 6/30/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)
Alcoholism Treatment Program
Service Type:
Program Name:
Certified Capacity:PRU 51910
with Telepractice Designation [with ancillary withdrawal services]
Outpatient Rehabilitation Service (822)
Alcoholism Treatment Program
Service Type:
Program Name:
Certified Capacity:PRU 53165
with Telepractice Designation
Administration for Children's Services, 185 Marcy Avenue, Brooklyn, NY 11211
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10578_NewYor.pdf
New York City Health and Hospitals Corporation Elmhurst Hospital Center
Mr. Israel Rocha, Chief Executive Officer
Annex O, 8th Floor, 79-01 Broadway, Elmhurst, NY 11373
Provider Number: 87040
Administrative Office:
Telephone - (718)-334-1638
Certificate Number: 220910464
Annex O, 2nd Floor, 79-01 Broadway, , Elmhurst, New York 11373
Effective: 04/14/2021 9/28/2022
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822) 300Service Type:
Program Name:
Certified Capacity:PRU 320
with Telepractice Designation [with ancillary withdrawal services for up to 30 patients]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10464_NewYor.pdf
Certificate Number: 220910900
Building H, 3rd Floor, 79-01 Broadway, Elmhurst, New York 11373
Effective: 04/14/2021 9/28/2022
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)
Elmhurst Hospital
Service Type:
Program Name:
Certified Capacity:PRU 50223
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10900_NewYor.pdf
January 31, 2022 Page 136 of 227
New York City Health and Hospitals Corporation Harlem Hospital Center
Ms. Eboné Carrington, Chief Executive Officer
Room MLK 2143, 506 Lenox Avenue, New York, NY 10037
Provider Number: 85130
Administrative Office:
Telephone - (212)-939-1340
Certificate Number: 230510610
Mural Pavilion, 5th Floor, 506 Lenox Avenue, , New York, New York 10037
Effective: 06/01/2021 5/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50316
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10610_NewYor.pdf
New York City Health and Hospitals Corporation Jacobi Medical Center
Mr. Christopher Mastromano, CEO
Building 1, Room 159, 1400 Pelham Parkway South, Bronx, NY 10461
Provider Number: 85140
Administrative Office:
Telephone - (718)-918-8141
Certificate Number: 220610609
Jacobi Medical Center, Floor #s 9W & 9N, Building #1, 1400 Pelham Parkway South, Bronx, New York 10461
Effective: 07/01/2021 6/30/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51889
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10609_NewYor.pdf
New York City Health and Hospitals Corporation Kings County Hospital Center
Mr. Sheldon McLeod, Chief Executive Officer
B Building, Suite B1137, 451 Clarkson Avenue, Brooklyn, NY 11203
Provider Number: 87030
Administrative Office:
Telephone - (718)-245-3901
Certificate Number: 240310462
Support Office Building (SOB), 591 Kingston Avenue, , Brooklyn, New York 11203
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:Deemed
Opioid Treatment Program (822) 750Service Type:
Program Name:
Certified Capacity:PRU 920
with Telepractice Designation [with ancillary withdrawal services for up to 75 patients]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10462_NewYor.pdf
Certificate Number: 220910574
R Building, 2 South Wing, 2nd Floor, 410 Winthrop Street, Brooklyn, New York 11203
Effective: 08/31/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51909
with Telepractice Designation [with ancillary withdrawal services]
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53163
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10574_NewYor.pdf
January 31, 2022 Page 137 of 227
New York City Health and Hospitals Corporation Lincoln Medical and Mental Health Center
Mr. Milton Nunez, Executive Director
234 East 149th Street, Bronx, NY 10451
Provider Number: 84150
Administrative Office:
Telephone - (718)-579-5700
Certificate Number: 220710894
545 East 142nd Street, Bronx, New York 10454
Effective: 07/31/2020 7/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Recovery Center at Belvis Diagnostic & Treatment Center
Service Type:
Program Name:
Certified Capacity:PRU 6813
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10894_NewYor.pdf
New York City Health and Hospitals Corporation Metropolitan Hospital Center
Ms. Alina Moran, Executive Director
Suite 1B2, 1901 First Avenue, New York, NY 10029
Provider Number: 81210
Administrative Office:
Telephone - (212)-423-7727
Certificate Number: 221010402
Psychiatric Pavillion, Room 2M29, 2nd Floor, 1900 2nd Avenue, , New York, New York 10029
Effective: 08/03/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 300Service Type:
Program Name:
Certified Capacity:PRU 669
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10402_NewYor.pdf
New York City Health and Hospitals Corporation Queens Hospital Center
Mr. Israel Rocha, CEO
Pavilion Building, Room 345, 82-50 164th Street, Jamaica, NY 11432
Provider Number: 87060
Administrative Office:
Telephone - (718)-883-2351
Certificate Number: 210510621
Pavilion Building, Room 345, 3rd Floor, 82-50 164th Street, , Jamaica, New York 11432
Effective: 08/21/2020 5/31/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)
Comprehensive Chemical Dependency Program
Service Type:
Program Name:
Certified Capacity:PRU 51908
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10621_NewYor.pdf
New York City Health and Hospitals Corporation Woodhull Medical and Mental Health Center
Mr Gregory J. Calliste, Chief Executive Officer
Administrative Office, 760 Broadway, Brooklyn, NY 11206
Provider Number: 85180
Administrative Office:
Telephone - (718)-519-3500
Certificate Number: 230310898
5th& 9th Floors, 760 Broadway, Brooklyn, New York 11206
Effective: 09/17/2020 3/7/2023
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50911
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10898_NewYor.pdf
January 31, 2022 Page 138 of 227
New York State Office of Addiction Services and Supports Bronx Addiction Treatment Center
Ms Tabatha Cotto,
Building #13, Room 205, 2nd Floor, 1500 Waters Place, Bronx, NY 10461
Provider Number: 90008
Administrative Office:
Telephone -
Certificate Number: 220311378
Building 13, 1500 Waters Place, , Bronx, New York 10461
Effective: 10/29/2019 3/31/2022
Program Location:
Special ReIssue Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Bronx ATC IP
38Service Type:
Program Name:
Certified Capacity:PRU 50740
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11378_NewYor.pdf
New York State Office of Addiction Services and Supports Charles K. Post Addiction Treatment Center
Ms. Elaine DuBissette, Director
Pilgrim Psychiatric Center Campus - Building 1, 998 Crooked Hill Road, West Brentwood, NY 11717
Provider Number: 90013
Administrative Office:
Telephone - (631)-434-7554
Certificate Number: 240911379
Pilgrim Psychiatric Center, Building 1, North Wing, 1st and 2nd Floors, 998 Crooked Hill Road, West Brentwood, New York 11717
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 51Service Type:
Program Name:
Certified Capacity:PRU 50749
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11379_NewYor.pdf
Certificate Number: 181211432
Pilgrim Psychiatric Center, First Floor, North Wing, Building 1, 998 Crooked Hill Road, West Brentwood, New York 11717
Effective: 07/24/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 42Service Type:
Program Name:
Certified Capacity:PRU 50753
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11432_NewYor.pdf
New York State Office of Addiction Services and Supports Creedmoor Addiction Treatment Center
Ms. Margaret Hurst, Director
Building 19, CBU 15, 80-45 Winchester Boulevard, Queens Village, NY 11427
Provider Number: 90009
Administrative Office:
Telephone - (718)-264-3755
Certificate Number: 240312127
Building 19, CBU 15, 80-45 Winchester Boulevard, Queens Village, New York 11427
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 26Service Type:
Program Name:
Certified Capacity:PRU 53203
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12127_NewYor.pdf
January 31, 2022 Page 139 of 227
New York State Office of Addiction Services and Supports Dick Van Dyke Addiction Treatment Center
Mr. Andrew Merrill, Director
Room 229, 1330 County Road 132, Ovid, NY 14521
Provider Number: 90003
Administrative Office:
Telephone - (315)-835-6153
Certificate Number: 240811381
[Mailing Address at], Ovid, New York 14521, 1330 County Road 132, 7116 County Road 132, Bldg. 112, [Services Provided at], Willard, New York 14588
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 30Service Type:
Program Name:
Certified Capacity:PRU 50725
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11381_NewYor.pdf
New York State Office of Addiction Services and Supports John L. Norris Addiction Treatment Center
Mr. Jason Goldwasser, Director
Building 1, Room 146, 1stFloor, 1111 Elmwood Avenue, Rochester, NY 14620
Provider Number: 90002
Administrative Office:
Telephone - (716)-461-0410 Ext 240
Certificate Number: 240211382
Rochester Psychiatric Center, Building 1, 1st Floor, 1732 South Avenue, Rochester, New York 14620
Effective: 03/01/2021 2/29/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 44Service Type:
Program Name:
Certified Capacity:PRU 50722
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11382_NewYor.pdf
New York State Office of Addiction Services and Supports Kingsboro Addiction Treatment Center
Ms. Vibeke Velez, Director
Main Building, Room 206, 2nd Floor, 754 Lexington Avenue, Brooklyn, NY 11221
Provider Number: 90014
Administrative Office:
Telephone - (718)-453-3200
Certificate Number: 240811383
754 Lexington Avenue, , Brooklyn, New York 11221
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 10Service Type:
Program Name:
Certified Capacity:PRU 51996
with Telepractice Designation [located in the East Wing, 5th Floor]**Any portion of these beds may be used for the provision of inpatient rehabilitation services, as needed. [With the use of Methadone]
Inpatient Rehabilitation Service ( 818) 60Service Type:
Program Name:
Certified Capacity:PRU 53442
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11383_NewYor.pdf
New York State Office of Addiction Services and Supports Margaret A. Stutzman Addiction Treatment Center
Mr. Robert Chapman, Executive Director
360 Forest Avenue, Buffalo, NY 14213
Provider Number: 90001
Administrative Office:
Telephone - (716)-882-4900 Ext 225
January 31, 2022 Page 140 of 227
Certificate Number: 240611385
Building 37, 360 Forest Avenue, Buffalo, New York 14213
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 33Service Type:
Program Name:
Certified Capacity:PRU 50719
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11385_NewYor.pdf
New York State Office of Addiction Services and Supports McPike Addiction Treatment Center
Mr. Stephen McLaughlin, Director
Room B203, 2nd Floor, 1213 Court Street, Utica, NY 13502
Provider Number: 90004
Administrative Office:
Telephone - (315)-738-4600
Certificate Number: 220211386
1213 Court Street, Utica, New York 13502
Effective: 03/01/2020 2/28/2022
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 68Service Type:
Program Name:
Certified Capacity:PRU 50727
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11386_NewYor.pdf
New York State Office of Addiction Services and Supports Richard C. Ward Addiction Treatment Center
Ms. Antonette Whyte-Etere, BATC Director
Administration Wing, Building 92 - Suite 12-16, 1st Floor, 117 Seward Avenue, Middletown, NY 10940
Provider Number: 90006
Administrative Office:
Telephone - (631)-403-3650
Certificate Number: 240912157
Building 92, Suites 12-16, 117 Seward Avenue, , Middletown, New York 10940
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 48Service Type:
Program Name:
Certified Capacity:PRU 53495
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12157_NewYor.pdf
New York State Office of Addiction Services and Supports Russell E. Blaisdell Addiction Treatment Center
Ms. Emily Feiner, Director
Building 57, 140 Old Orangeburg Road, Orangeburg, NY 10962
Provider Number: 90007
Administrative Office:
Telephone - (845)-680-7638 Ext 7638
Certificate Number: 241011387
Rockland Psychiatric Center, Building 57, 5th and 6th Floors, 140 Old Orangeburg Road, , Orangeburg, New York 10962
Effective: 11/01/2021 10/31/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 52Service Type:
Program Name:
Certified Capacity:PRU 50735
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11387_NewYor.pdf
January 31, 2022 Page 141 of 227
New York State Office of Addiction Services and Supports South Beach Addiction Treatment Center
Ms. Nadia Huntley-Smith, Director
South Beach Psychiatric Center, Building 3, Room 807, 2nd Floor, 777 Seaview Avenue, Staten Island, NY 10305
Provider Number: 90012
Administrative Office:
Telephone - (718)-667-5202
Certificate Number: 241111388
South Beach Psychiatric Center, Building 3, 777 Seaview Avenue, Staten Island, New York 10305
Effective: 12/01/2021 11/30/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 30Service Type:
Program Name:
Certified Capacity:PRU 50748
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11388_NewYor.pdf
New York State Office of Addiction Services and Supports St. Lawrence Addiction Treatment Center
Mr. William Coppola, Director
Hamilton Hall, 1 Chimney Point Drive, Ogdensburg, NY 13669
Provider Number: 90005
Administrative Office:
Telephone - (315)-393-1180
Certificate Number: 240311389
1 Chimney Point Drive, Ogdensburg, New York 13669
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 40Service Type:
Program Name:
Certified Capacity:PRU 50730
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11389_NewYor.pdf
New York State Office of Children and Family Services
Ms. Sheila J. Poole, Acting Commissioner
Office of Program Services/Division of Rehabilitation Services, Capital View Office Park, 6th Floor, 52 Washington Street, Rensselaer, NY 12144
Provider Number: 28720
Administrative Office:
Telephone - (845)-615-3011
Certificate Number: 180611788
Brookwood Secure Center, 419 Spookrock Road, P.O. Box 265, Claverack, New York 12513
Effective: 01/01/2018 6/30/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Chemical Dependency Specialized Services (824)
Discrete Addiction Service Unit
30Service Type:
Program Name:
Certified Capacity:PRU 52649
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11788_NewYor.pdf
Certificate Number: 180611791
Highland Residential Center, Unit #41, 629 North Chodikee Lake Road, PO Box 970, Highland, New York 12528
Effective: 01/01/2018 6/30/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Chemical Dependency Specialized Services (824)
Discrete Addiction Service Unit
17Service Type:
Program Name:
Certified Capacity:PRU 52651
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11791_NewYor.pdf
January 31, 2022 Page 142 of 227
New York Therapeutic Communities, Inc.
Mr Sandeep Varma, Chief Executive Officer/President
21st Floor, 266 West 37th Street, New York, NY 10018
Provider Number: 587
Administrative Office:
Telephone - (212)-971-6033
Certificate Number: 231110210
2071 Fulton Street, Brooklyn, New York 11233
Effective: 12/01/2021 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Serendipity I - The John David Center
57Service Type:
Program Name:
Certified Capacity:PRU 5682
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10210_NewYor.pdf
Certificate Number: 181211306
Floors 1-4, 944 Bedford Avenue, , Brooklyn, New York 11205
Effective: 01/17/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Serendipity II - The Madeline Randers Center
40Service Type:
Program Name:
Certified Capacity:PRU 7191
for women
Intensive Residential Rehabilitation (819)
Serendipity II - The Madeline Randers Center
40Service Type:
Program Name:
Certified Capacity:PRU 7191
for women
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11306_NewYor.pdf
Certificate Number: 210911486
2071 Fulton Street, Brooklyn, New York 11233
Effective: 04/25/2019 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51994
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11486_NewYor.pdf
Certificate Number: 221111583
Lower Level, 162-24 Jamaica Avenue, Jamaica, New York 11432
Effective: 10/02/2020 11/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52057
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11583_NewYor.pdf
Niagara County Department of Mental Health Services
Ms. Laura Kelemen, Director
Suite #200, 5467 Upper Mountain Road, Lockport, NY 14094
Provider Number: 70150
Administrative Office:
Telephone - (716)-439-7410
January 31, 2022 Page 143 of 227
Certificate Number: 220512026
Trott Access Center, 2nd Floor, 1001 11th Street, Niagara Falls, New York 14301
Effective: 09/04/2020 5/31/2022
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52984
with Telepractice Designation
Shaw Building, 5467 Upper Mountain Road, Lockport, NY 14094
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12026_Niagar.pdf
North Country Freedom Homes, Inc.
Ms. Jennifer Barron, Director of Services
25 Dies Street, Canton, NY 13617
Provider Number: 36160
Administrative Office:
Telephone - (315)-379-0139 Ext 4
Certificate Number: 181210151
25 Dies Street, Canton, New York 13617
Effective: 01/01/2018 12/31/2018
Program Location:
Conditional Certificate Anticipated Recert Review:
Community Residential (819)
Canton House Community Residential Service
24Service Type:
Program Name:
Certified Capacity:PRU 50499
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10151_NorthC.pdf
North Crown Heights Family Outreach Center, Inc.
Ms. Susana Dobrer, Executive Director
765 Nostrand Avenue #763, Brooklyn, NY 11216
Provider Number: 42930
Administrative Office:
Telephone - (718)-230-8600
Certificate Number: 230511459
763-765 Nostrand Avenue, Brooklyn, New York 11216
Effective: 06/01/2021 5/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51973
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11459_NorthC.pdf
North Shore Child and Family Guidance Association, Inc.
Mr. Andrew Malekoff, Executive Director/CEO
480 Old Westbury Road, Roslyn Heights, NY 11577
Provider Number: 21730
Administrative Office:
Telephone - (516)-626-1971 Ext 302
Certificate Number: 211211497
999 Brush Hollow Road, Westbury, New York 11590
Effective: 06/22/2020 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51657
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11497_NorthS.pdf
January 31, 2022 Page 144 of 227
Northpointe Council, Inc.
Ms. Kristi Yerger, President & CEO
Suite 2A, 800 Main Street, Niagara Falls, NY 14301
Provider Number: 38020
Administrative Office:
Telephone - (716)-282-1228
Certificate Number: 190710509
2470 Allen Avenue, Niagara Falls, New York 14303
Effective: 01/01/2018 7/31/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Medically Monitored Withdrawal & Stabilization Services (816.9)
First Step Center
17Service Type:
Program Name:
Certified Capacity:PRU 8028
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10509_Northp.pdf
Certificate Number: 220910656
Lockview Plaza, Suite 201, Second Floor, 41 Main Street, Lockport, New York 14094
Effective: 04/09/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50083
with Telepractice Designation
6395 Old Niagara Road, Lockport, NY 14094
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10656_Northp.pdf
Certificate Number: 240611250
1001 11th Street, Niagara Falls, New York 14301
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51852
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11250_Northp.pdf
Certificate Number: 221011696
1001 11th Street, , Niagara Falls, New York 14301
Effective: 04/09/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Full Agonist Treatment Program (822) 85Service Type:
Program Name:
Certified Capacity:PRU 52232
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11696_Northp.pdf
Certificate Number: 210712075
2470 Allen Avenue, Niagara Falls, New York 14303
Effective: 08/01/2018 7/31/2021
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
First Step Center
7Service Type:
Program Name:
Certified Capacity:PRU 52971
- [up to 7 beds may be used for the provision of medically monitored withdrawal & stabilization services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12075_Northp.pdf
January 31, 2022 Page 145 of 227
Northwell Healthcare, Inc. as Sponsor Phelps Memorial Hospital Association as Operator
Ms. Eileen Egan, Executive Director
Administration - 1st Floor, 701 North Broadway, Sleepy Hollow, NY 10591
Provider Number: 85310
Administrative Office:
Telephone -
Certificate Number: 220910597
22 Rockledge Avenue, Ossining, New York 10562
Effective: 04/22/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51620
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51941
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10597_Northw.pdf
Certificate Number: 220911392
2nd Floor (South Wing), 701 North Broadway, , Sleepy Hollow, New York 10591
Effective: 10/02/2020 9/28/2022
Program Location:
Amendment Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
Behavioral Rehabilitation Unit
22Service Type:
Program Name:
Certified Capacity:PRU 51617
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11392_Northw.pdf
Northwell Healthcare, Inc. as Sponsor The Long Island Home d/b/a South Oaks Hospital as Operator
Mr Michael Scarpelli, Executive Director
400 Sunrise Highway, Amityville, NY 11701
Provider Number: 81980
Administrative Office:
Telephone - (631)-608-5105
Certificate Number: 210110634
Carone Hall, Basement and First Floor, 400 Sunrise Highway, , Amityville, New York 11701
Effective: 06/22/2020 1/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Outpatient Substance Use Disorder Clinic
Service Type:
Program Name:
Certified Capacity:PRU 50697
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10634_Northw.pdf
Certificate Number: 210111424
Jennings Hall, 1st Floor, 400 Sunrise Highway, Amityville, New York 11701
Effective: 02/19/2020 1/31/2021
Program Location:
Establishment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 28Service Type:
Program Name:
Certified Capacity:PRU 50696
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11424_Northw.pdf
January 31, 2022 Page 146 of 227
Certificate Number: 210111489
Jennings Hall, 2nd Floor, 400 Sunrise Highway, Amityville, New York 11701
Effective: 02/19/2020 1/31/2021
Program Location:
Establishment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 24Service Type:
Program Name:
Certified Capacity:PRU 50695
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11489_Northw.pdf
Northwell Healthcare, Inc. as Sponsor, John T. Mather Hospital of Port Jefferson, New York, Inc. as Operator
Mr. Kenneth Roberts, President
75 North Country Road, Port Jefferson, NY 11777
Provider Number: 83220
Administrative Office:
Telephone - (631)-473-1320 Ext 4215
Certificate Number: 240810840
1st Floor, 100 Highlands Boulevard, , Port Jefferson, New York 11777
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Mather Outpatient Chemical Dependence Program
Service Type:
Program Name:
Certified Capacity:PRU 50023
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10840_Northw.pdf
Northwell Healthcare, Inc. as Sponsor, Long Island Jewish Medical Center as Operator
Carolyn Sweetapple Ph.D., Executive Director
ACP Suite 2309, 75-59 263rd Street, Glen Oaks, NY 11004
Provider Number: 85210
Administrative Office:
Telephone - (718)-470-4887
Certificate Number: 221010450
(Clinic) 75-59 263rd Street, 1st Floor, Glen Oaks, NY 11004-1150 , (Billing), 270-05 76th Avenue, , New Hyde Park, New York 11040
Effective: 05/28/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 375Service Type:
Program Name:
Certified Capacity:PRU 307
with Telepractice Designation [with ancillary withdrawal services for up to 38 patients]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10450_Northw.pdf
Certificate Number: 211010557
1st Floor Suite 160 and 2, 600 Hempstead Turnpike, , West Hempstead, New York 11552
Effective: 05/28/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Project Outreach
Service Type:
Program Name:
Certified Capacity:PRU 431
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10557_Northw.pdf
Certificate Number: 221010639
2nd Floor, 1600 Central Avenue, Far Rockaway, New York 11691
Effective: 05/28/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50021
with Telepractice Designation
January 31, 2022 Page 147 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10639_Northw.pdf
Certificate Number: 221010855
(Clinic) 75-59 263rd Street, Basement, Glen Oaks, New York 11004-1150, (Billing), 270-05 76th Avenue, , New Hyde Park, New York 11040
Effective: 05/28/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 3089
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10855_Northw.pdf
Certificate Number: 221010858
711 Stewart Avenue, , Garden City, New York 11530
Effective: 05/28/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Garden City Treatment Center
Service Type:
Program Name:
Certified Capacity:PRU 50064
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10858_Northw.pdf
Northwell Healthcare, Inc. as Sponsor, Staten Island University Hospital as Operator
Brahim Ardolic M.D., Executive Director
475 Seaview Avenue, Staten Island, NY 10305
Provider Number: 85200
Administrative Office:
Telephone - (718)-226-9761
Certificate Number: 221210446
111 Water Street, Staten Island, New York 10304
Effective: 03/10/2021 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 220Service Type:
Program Name:
Certified Capacity:PRU 944
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10446_Northw.pdf
Certificate Number: 211010447
Methadone Annex, 1st & 2nd Floors, 392 Seguine Avenue, , Staten Island, New York 10309
Effective: 03/10/2021 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 550Service Type:
Program Name:
Certified Capacity:PRU 304
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10447_Northw.pdf
Certificate Number: 211010449
1st Floor, 567 East 105th Street, , Brooklyn, New York 11236
Effective: 03/10/2021 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 400Service Type:
Program Name:
Certified Capacity:PRU 7150
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10449_Northw.pdf
January 31, 2022 Page 148 of 227
Certificate Number: 221011027
Original Building, North & South Wings, 2nd Floor, 392 Seguine Avenue, Staten Island, New York 10309
Effective: 03/10/2021 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51422
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11027_Northw.pdf
Certificate Number: 221011406
Main Hospital Building, 3rd Floor, North Wing, 375 Seguine Avenue, , Staten Island, New York 10309
Effective: 12/09/2021 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Staten Island University Hospital Prince's Bay
24Service Type:
Program Name:
Certified Capacity:PRU 51623
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11406_Northw.pdf
Ocean Recovery East, LLC d/b/a Ascendant New York
Mr. Tzvi Heber, CEO
113 East 60th Street, New York, NY 10022
Provider Number: 49900
Administrative Office:
Telephone - (917)-262-0003
Certificate Number: 221212126
Floors 1-6, 113 East 60th Street, New York, New York 10022
Effective: 11/30/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 15Service Type:
Program Name:
Certified Capacity:PRU 53204
with Telepractice Designation [up to 6 of these beds may be used for the provision of inpatient rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12126_OceanR.pdf
Certificate Number: 201212220
Basement, Rooms 005, 006, 007, 010, 1st Floor, Rooms 102, 107, 113 East 60th Street, , New York, New York 10022
Effective: 10/02/2020 12/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53264
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12220_OceanR.pdf
Certificate Number: 241012243
5th & 6th Floors, 113 East 60th Street, , New York, New York 10022
Effective: 11/01/2021 10/31/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Ascendant NY
3Service Type:
Program Name:
Certified Capacity:PRU 53520
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12243_OceanR.pdf
January 31, 2022 Page 149 of 227
Oceanside Counseling Center, Inc.
Ms Teresa Maguire, Director
71 Homecrest Court, Oceanside, NY 11572
Provider Number: 11500
Administrative Office:
Telephone - (516)-766-6283 Ext 14
Certificate Number: 210810910
School Building 6, 2nd Floor, 71 Homecrest Court, , Oceanside, New York 11572
Effective: 06/22/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6438
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10910_Oceans.pdf
Odyssey House, Inc.
Peter Provet Ph.D., President and Chief Executive Officer
17th Floor, 120 Wall Street, New York, NY 10005
Provider Number: 19400
Administrative Office:
Telephone - (212)-361-1617
Certificate Number: 181210052
219-233 East 121st Street, New York, New York 10035
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Odyssey Manor
196Service Type:
Program Name:
Certified Capacity:PRU 6817
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10052_Odysse.pdf
Certificate Number: 181210053
Basement, 1st-4th Floors, 309-311 East 6th Street, New York, New York 10003
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 60Service Type:
Program Name:
Certified Capacity:PRU 957
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10053_Odysse.pdf
Certificate Number: 181210055
George Rosenfeld Center for Recovery, 13 Hell Gate Circle, Ward's Island, New York 10035
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Odyssey Ward's Island
97Service Type:
Program Name:
Certified Capacity:PRU 52848
Intensive Residential Rehabilitation (819)
Odyssey Ward's Island
74Service Type:
Program Name:
Certified Capacity:PRU 53066
and up to 60 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10055_Odysse.pdf
Certificate Number: 210611460
Suite 301, 3rd Floor, 953 Southern Boulevard, Bronx, New York 10459
Effective: 08/25/2020 6/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7392
with Telepractice Designation
January 31, 2022 Page 150 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11460_Odysse.pdf
Certificate Number: 190411582
1264 Lafayette Avenue, Bronx, New York 10474
Effective: 01/01/2018 4/30/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 16Service Type:
Program Name:
Certified Capacity:PRU 52056
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11582_Odysse.pdf
Certificate Number: 200811793
1328 Clinton Avenue, 1322, 1326 &, Bronx, New York 10456
Effective: 01/01/2018 8/31/2020
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 57Service Type:
Program Name:
Certified Capacity:PRU 52659
and up to 14 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11793_Odysse.pdf
One Brooklyn Health System, Inc. as Active Parent and Co-Operator, Brookdale Hospital as Co-Operator
Ms LaRay Brown, President/CEO
1545 Atlantic Avenue, Brooklyn, NY 11213
Provider Number: 85470
Administrative Office:
Telephone - (718)-613-4001
Certificate Number: 240410300
6 East, 1545 Atlantic Avenue, Brooklyn, New York 11213
Effective: 10/27/2021 4/23/2024
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 20Service Type:
Program Name:
Certified Capacity:PRU 50586
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10300_OneBro.pdf
Certificate Number: 240510457
880 Bergen Street, , Brooklyn, New York 11238
Effective: 10/29/2021 5/7/2024
Program Location:
Correction Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Interfaith Medical Center MMTP Clinic
450Service Type:
Program Name:
Certified Capacity:PRU 335
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10457_OneBro.pdf
Certificate Number: 221010834
Bishop O.G. Walker, Jr. Health Center, 528 Prospect Place, , Brooklyn, New York 11238
Effective: 10/27/2021 10/4/2022
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50587
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53012
with Telepractice Designation
January 31, 2022 Page 151 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10834_OneBro.pdf
Certificate Number: 221011371
6 West, 1545 Atlantic Avenue, Brooklyn, New York 11213
Effective: 10/27/2021 10/4/2022
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818) 20Service Type:
Program Name:
Certified Capacity:PRU 7038
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11371_OneBro.pdf
Onondaga-Cortland-Madison BOCES
Mr. Phil Grome, Assistant Superintendent for Administration
110 Elwood Davis Road, Syracuse, NY 13121
Provider Number: 36380
Administrative Office:
Telephone - (315)-433-2614
Certificate Number: 220612014
Administrative Site Only:, 110 Elwood Davis Road, , Syracuse, New York 13121
Effective: 07/01/2019 6/30/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90696
Immaculate Conception School, 400 Salt Springs Road, Fayetteville, NY 13066
Other Service Site(s) At:
Blessed Sacrament School, 3129 James Street, Syracuse, NY 13206
Other Service Site(s) At:
St. Mary's Academy, 49 Syracuse Street, Baldwinsville, NY 13027
Other Service Site(s) At:
Our Lady of Pompei School, 923 North McBride Street, Syracuse, NY 13208
Other Service Site(s) At:
St. Margaret's School, 200 Roxboro Road, Mattydale, NY 13211
Other Service Site(s) At:
Bishop Grimes JHS, 6653 Kirkville Road, East Syracuse, NY 13057
Other Service Site(s) At:
Bishop Ludden, 815 Fay Road, Syracuse, NY 13219
Other Service Site(s) At:
St. Rose of Lima School, 411 South Main Street, North Syracuse, NY 13212
Other Service Site(s) At:
Most Holy Rosary School, 1031 Bellevue Avenue, Syracuse, NY 13207
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12014_Ononda.pdf
Open Arms, Incorporated
Ms. Barbara Swift, Executive Director
57-59 Sharp Street, Haverstraw, NY 10927
Provider Number: 34360
Administrative Office:
Telephone - (845)-271-3787
January 31, 2022 Page 152 of 227
Certificate Number: 181210119
57-59 Sharp Street, Haverstraw, New York 10927
Effective: 01/01/2018 12/31/2018
Program Location:
Conditional Certificate Anticipated Recert Review:
Community Residential (819)
Open Arms Halfway House
18Service Type:
Program Name:
Certified Capacity:PRU 50943
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10119_OpenAr.pdf
Certificate Number: 181211472
57-59 Sharp Street, Haverstraw, New York 10927
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819) 20Service Type:
Program Name:
Certified Capacity:PRU 51524
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11472_OpenAr.pdf
Certificate Number: 181211771
74 Hudson Avenue, , Haverstraw, New York 10927
Effective: 01/01/2018 12/31/2018
Program Location:
Conditional Certificate Anticipated Recert Review:
Community Residential (819) 12Service Type:
Program Name:
Certified Capacity:PRU 52613
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11771_OpenAr.pdf
Osborne Treatment Services, Inc.
Ms. Elizabeth Gaynes, President/CEO
809 Westchester Avenue, Bronx, NY 10455
Provider Number: 1879
Administrative Office:
Telephone - (718)-707-2600
Certificate Number: 240511272
Basement, 1st-3rd Floors, 809 Westchester Avenue, Bronx, New York 10455
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7323
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11272_Osborn.pdf
Oswego County Opportunities, Inc.
Ms. Diane Cooper-Currier, Executive Director
239 Oneida Street, Fulton, NY 13069
Provider Number: 40660
Administrative Office:
Telephone - (315)-598-4717 Ext 1017
Certificate Number: 190810186
239 Oneida Street, RECORDS ONLY are located at:, Fulton, New York 13069-1228, 53 Hall Road, R.D. #1, Hannibal, New York 13074
Effective: 01/01/2018 8/31/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819)
Arbor House Supportive Living Program
10Service Type:
Program Name:
Certified Capacity:PRU 51425
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10186_Oswego.pdf
January 31, 2022 Page 153 of 227
Certificate Number: 181210187
53 Hall Road, Hannibal, New York 13074
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Arbor House
16Service Type:
Program Name:
Certified Capacity:PRU 50966
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10187_Oswego.pdf
Otsego County Community Services Board
Jeannette Pavlus, Director
3rd Floor, 242 Main Street, Oneonta, NY 13820
Provider Number: 70120
Administrative Office:
Telephone - (607)-433-2343
Certificate Number: 221210917
Otsego County Satellite Office Building, 2nd Floor, 242 Main Street, Oneonta, New York 13820
Effective: 07/10/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Otsego County Community Services Chemical Dependencies Clinic
Service Type:
Program Name:
Certified Capacity:PRU 50325
with Telepractice Designation
140 County Highway 33W, Cooperstown, NY 13326
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10917_Otsego.pdf
Our Lady of Lourdes Memorial Hospital
Ms. Kathryn Connerton, Chief Executive Officer
169 Riverside Drive, Binghamton, NY 13905
Provider Number: 82150
Administrative Office:
Telephone - (607)-798-5334
Certificate Number: 210211968
Administrative Site Only:, 184 Court Street, Binghamton, New York 13901
Effective: 03/01/2019 2/28/2021
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90733
Chenango Valley High School, 2nd Floor, Guidance Office, 221 Chenango Bridge Road, Binghamton, NY 13901
Other Service Site(s) At:
Johnson City Middle School, Room 114D, 601 Columbia Drive, Johnson City, NY 13790
Other Service Site(s) At:
Leslie F. Distin Education Center BOCES, 435 Glenwood Road, Binghamton, NY 13905
Other Service Site(s) At:
Deposit High School, 1st Floor, Guidance Office, 171 2nd Street, Deposit, NY 13754
Other Service Site(s) At:
Windsor High School, Upper Level, Guidance Office, 1191 Route 79, Windsor, NY 13865
Other Service Site(s) At:
Broome-Tioga BOCES East Learning Center (Columbus), 2nd Floor, Room 200B, 164 Hawley Street, Binghamton, NY 13901
Other Service Site(s) At:
Chenango Forks High School, 1st Floor, Room 100-1, 1 Gordon Drive, Binghamton, NY 13901
Other Service Site(s) At:
Binghamton High School, 3rd Floor, Room A307, 31 Main Street, Binghamton, NY 13905
Other Service Site(s) At:
January 31, 2022 Page 154 of 227
Maine-Endwell Middle School, 1st Floor, Room #142, 1119 Farm To Market Road, Endwell, NY 13760
Other Service Site(s) At:
Seton Catholic Central High School, Main Level, Guidance Office, 70 Seminary Avenue, Binghamton, NY 13905
Other Service Site(s) At:
Whitney Point High School, 1st Floor, Guidance Suite, 10 Keibel Road, Whitney Point, NY 13862
Other Service Site(s) At:
Maine-Endwell High School, 1st Floor, Room 116.3, 750 Farm to Market Road, Endwell, NY 13760
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11968_OurLad.pdf
Outreach Development Corporation
Ms. Debra Pantin, President/CEO
Richmond Hill Building, 2nd Floor, 117-11 Myrtle Avenue, Richmond Hill, NY 11418
Provider Number: 31360
Administrative Office:
Telephone - (718)-847-9233 Ext 2232
Certificate Number: 211110561
Unit C and D, 1st Floor, 11 Farber Drive, , Bellport, New York 11713
Effective: 04/22/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Outreach Project - Bellport
Service Type:
Program Name:
Certified Capacity:PRU 6594
with Telepractice Designation
Outpatient Rehabilitation Service (822)
Outreach Project - Bellport
Service Type:
Program Name:
Certified Capacity:PRU 6635
with Telepractice Designation
Longwood High School, 100 Longwood Road, Middle Island, NY 11953
Additional Location(s) At:
OTI Building, 1st Floor, Office #2 and Conference Room #2, 400 Crooked Hill Road, Brentwood, NY 11717
Additional Location(s) At:
Mercy First -Syosset Campus, 525 Convent Road, Syosset, NY 11791
Additional Location(s) At:
Eastern Suffolk BOCES-Bellport Academic Center, 350 Martha Avenue, Bellport, NY 11713
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10561_Outrea.pdf
Certificate Number: 240810563
Basement, 1st and 2nd Floors, 117-11 Myrtle Avenue, Richmond Hill, New York 11418
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
The Outreach Project
Service Type:
Program Name:
Certified Capacity:PRU 7210
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10563_Outrea.pdf
January 31, 2022 Page 155 of 227
Certificate Number: 221211273
2nd & 3rd Floors, 960 Manhattan Avenue, Brooklyn, New York 11222
Effective: 04/22/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51847
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11273_Outrea.pdf
Certificate Number: 211011790
452 Suffolk Avenue, Brentwood, New York 11717
Effective: 04/22/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52648
with Telepractice Designation
Pilgrim Psychiatric Center, Buckman Clinic - Building #47, 998 Crooked Hill Road, Brentwood, NY 11717
Additional Location(s) At:
Pilgrim Psychiatric Center-Building #56, Western Suffolk Clinic - Building #56, 998 Crooked Hill Road, Brentwood, NY 11717
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11790_Outrea.pdf
Certificate Number: 240212031
and Basement, 1st-3rd Floors, 16-14 Weirfield Street, Ridgewood, New York 11385
Effective: 03/01/2021 2/29/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Rehabilitation Services for Youth (817) 30Service Type:
Program Name:
Certified Capacity:PRU 53003
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12031_Outrea.pdf
Certificate Number: 240912032
400 Crooked Hill Road, Brentwood, New York 11717
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Rehabilitation Services for Youth (817) 45Service Type:
Program Name:
Certified Capacity:PRU 53002
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10093_Outrea.pdf
Certificate Number: 210612076
Pilgrim Psychiatric Center, Building #5, 1st and 2nd Floors, 998 Crooked Hill Road, , Brentwood, New York 11717
Effective: 01/25/2021 6/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53093
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12076_Outrea.pdf
January 31, 2022 Page 156 of 227
Certificate Number: 201212219
27A Washington Place, , Roosevelt, New York 11575
Effective: 04/22/2020 12/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Outreach's REACT Center
Service Type:
Program Name:
Certified Capacity:PRU 53483
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12219_Outrea.pdf
Certificate Number: 240812221
Building #4, 400 Crooked Hill Road, , Brentwood, New York 11717
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Outreach's Recovery Residence for Women
25Service Type:
Program Name:
Certified Capacity:PRU 53263
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12221_Outrea.pdf
Certificate Number: 220412264
Pilgrim Psychiatric Center, Building #5, 1st and 2nd Floors, 998 Crooked Hill Road, , Brentwood, New York 11717
Effective: 05/07/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820) 36Service Type:
Program Name:
Certified Capacity:PRU 53558
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12264_Outrea.pdf
The PAC Program of the Bronx, Inc.
Ms. Maria Mendez, Executive Vice President/COO
1215-1217 Stratford , Bronx, NY 10472
Provider Number: 47080
Administrative Office:
Telephone - (718)-328-2605
Certificate Number: 221211691
1215-1217 Stratford Avenue, Bronx, New York 10472
Effective: 06/05/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52233
with Telepractice Designation
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52233
with Telepractice Designation
11th Floor, 15 West 39th Street, New York, NY 10018
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11691_PACPro.pdf
Parallax Center, Inc.
David Ockert Ph.D., Executive Director
6th Floor, 145 East 32nd Street, New York, NY 10016
Provider Number: 1898
Administrative Office:
Telephone - (212)-779-9207
January 31, 2022 Page 157 of 227
Certificate Number: 240910500
6th Floor, 145 East 32nd Street, New York, New York 10016
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 25Service Type:
Program Name:
Certified Capacity:PRU 8020
[without the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10500_Parall.pdf
Certificate Number: 220710920
6th Floor, 145 East 32nd Street, New York, New York 10016
Effective: 09/01/2020 7/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 5513
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10920_Parall.pdf
Pearl Street Counseling Center, Inc.
Mr. Guy Kuperman, Executive Director
1st Floor, 109 State Street, Albany, NY 12207
Provider Number: 651
Administrative Office:
Telephone - (518)-462-4320
Certificate Number: 210611525
1st Floor, 109 State Street, Albany, New York 12207
Effective: 07/01/2019 6/30/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 1694
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11525_PearlS.pdf
Phoenix Houses of Long Island, Inc.
Ms. Ann Marie M. Foster, President and CEO
34-11 Vernon Boulevard, Long Island City, NY 11106
Provider Number: 50570
Administrative Office:
Telephone - (718)-222-6673
Certificate Number: 181211308
220 Veterans Memorial Highway, Hauppauge, New York 11788
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Phoenix House Hauppauge Center
65Service Type:
Program Name:
Certified Capacity:PRU 2013
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11308_Phoeni.pdf
Certificate Number: 181211310
95 Industrial Road, Wainscott, New York 11975
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Phoenix House Academy of Long Island
45Service Type:
Program Name:
Certified Capacity:PRU 6298
with Telepractice Designatioin
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11310_Phoeni.pdf
January 31, 2022 Page 158 of 227
Certificate Number: 231011778
287 Springs-Fireplace Road, East Hampton, New York 11937
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
East Hampton Outpatient Services
Service Type:
Program Name:
Certified Capacity:PRU 52627
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11778_Phoeni.pdf
Certificate Number: 230412080
Basement, 1st-5th Floors, 34-25 Vernon Boulevard, Long Island City, New York 11106
Effective: 05/01/2021 4/30/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 190Service Type:
Program Name:
Certified Capacity:PRU 53073
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12080_Phoeni.pdf
Certificate Number: 200212155
153, 153A, and 161 Lake Shore Road, , Lake Ronkonkoma, New York 11779
Effective: 03/04/2019 2/29/2020
Program Location:
Conversion Anticipated Recert Review:
Residential Services (820)
Phoenix House - Lake Ronkonkoma
96Service Type:
Program Name:
Certified Capacity:PRU 53273
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12155_Phoeni.pdf
Certificate Number: 220112184
1st Floor, 34-11 Vernon Boulevard, , Long Island City, New York 11106
Effective: 06/10/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Parkside Outpatient Program
Service Type:
Program Name:
Certified Capacity:PRU 53318
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12184_Phoeni.pdf
Postgraduate Center for Mental Health
Mr. Jacob Barak, CEO
158 East 35th Street, New York, NY 10016
Provider Number: 18270
Administrative Office:
Telephone - (212)-899-5500 Ext 205
Certificate Number: 220512190
8th Floor, 1775 Grand Concourse, , Bronx, New York 10453
Effective: 06/01/2021 5/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Bronx Recovery Support Center
Service Type:
Program Name:
Certified Capacity:PRU 53437
with Telepractice Designation
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
January 31, 2022 Page 159 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12190_Postgr.pdf
PRCD, Inc.
Ms Mandy Teeter, Vice President, Rochester Regional Health-Behavioral Health
3rd Floor, 81 Lake Avenue, Rochester, NY 14608
Provider Number: 37360
Administrative Office:
Telephone - (585)-922-5497
Certificate Number: 181210266
2650 Ridgeway Avenue, Rochester, New York 14626
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Barbara Wolk Schwarz Women Residence
24Service Type:
Program Name:
Certified Capacity:PRU 51037
for women and with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10266_PRCDIn.pdf
The Prevention Council of Erie County, Inc.
Ms. Robin Mann, Executive Director
1625 Hertel Avenue, Buffalo, NY 14216
Provider Number: 38040
Administrative Office:
Telephone - (716)-831-2298
Certificate Number: 211112001
1st Floor, 1625 Hertel Avenue, Buffalo, New York 14216
Effective: 02/03/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Prevention Counseling
Student Assistance Prevention Counseling Program
Service Type:
Program Name:
Certified Capacity:PRU 90711
School #66 - North Park Middle Academy, Guidance Office, 780 Parkside Avenue, Buffalo, NY 14216
Other Service Site(s) At:
School # 19 - Native American Magnet, 2nd Floor, Room 210, 238 Ontario Street, Buffalo, NY 14207
Other Service Site(s) At:
Enterprise Charter School, 1st Floor, Social Worker's Office, 275 Oak Street, Buffalo, NY 14203
Other Service Site(s) At:
Riverside Institute of Technology, Room 131, 51 Ontario Street, Buffalo, NY 14215
Other Service Site(s) At:
McKinley High School, Room 210, 1500 Elmwood Avenue, Buffalo, NY 14207
Other Service Site(s) At:
East High School, 820 Northampton Avenue, Buffalo, NY 14211
Other Service Site(s) At:
Lackawanna High/Middle School, Guidance Office, 550 Martin Road, Lackawanna, NY 14218
Other Service Site(s) At:
Bennett High School, 2885 Main Street, Buffalo, NY 14214
Other Service Site(s) At:
School #18, Room 316, 118 Hampshire Street, Buffalo, NY 14213
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12001_ErieCo.pdf
Professional Counseling Services, Inc.
Ms. Darlene Angelicchio, President
Medical Center West, Suite #118, 1st Floor, 5700 West Genesee Street, Camillus, NY 13031
Provider Number: 49850
Administrative Office:
Telephone - (315)-488-1641
January 31, 2022 Page 160 of 227
Certificate Number: 220112121
Medical Center West, Suite #118, 1st Floor, 5700 West Genesee Street, , Camillus, New York 13031
Effective: 05/04/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53177
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12121_Profes.pdf
Project Hospitality, Inc.
Ms. Jaclyn Stoll, Interim Executive Director
100 Park Avenue, Staten Island, NY 10302
Provider Number: 19900
Administrative Office:
Telephone - (718)-448-1544 Ext 110
Certificate Number: 230610948
14 Slosson Terrace, Staten Island, New York 10301
Effective: 07/01/2021 6/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51157
with Telepractice Designation
New York City Administration for Children's Services, 3rd and 5th Floors, 350 St. Mark's Place, Staten Island, NY 10301
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10948_Projec.pdf
Certificate Number: 240812148
Bayley Seton Campus, 1st Floor - F Wing, 75 Vanderbilt Avenue, Staten Island, New York 10304
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
PREP
20Service Type:
Program Name:
Certified Capacity:PRU 53232
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12148_Projec.pdf
Project Renewal, Inc.
Mr. Eric Rosenbaum, President & Chief Executive Officer
9th Floor, 200 Varick Street, New York, NY 10014
Provider Number: 50470
Administrative Office:
Telephone - (212)-620-0340
Certificate Number: 231110196
4th Floor, Eight East Third Street, New York, New York 10003
Effective: 12/01/2021 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Medically Monitored Withdrawal & Stabilization Services (816.9) 30Service Type:
Program Name:
Certified Capacity:PRU 51112
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10196_Projec.pdf
January 31, 2022 Page 161 of 227
Certificate Number: 210910949
1st Floor, 8 East Third Street, New York, New York 10003
Effective: 06/05/2020 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Project Renewal Chemical Dependence Outpatient Clinic
Service Type:
Program Name:
Certified Capacity:PRU 50052
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10949_Projec.pdf
Certificate Number: 210211600
2nd & 3rd Floors, 8 East Third Street, , New York, New York 10003
Effective: 10/21/2020 2/17/2021
Program Location:
Emergency Anticipated Recert Review:
Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 30Service Type:
Program Name:
Certified Capacity:PRU 52081
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11600_Projec.pdf
Certificate Number: 210112224
2nd Floor, 179 East 116th Street, , New York, New York 10029
Effective: 11/19/2020 1/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Project Renewal Support and Connection Center
Service Type:
Program Name:
Certified Capacity:PRU 53475
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Putnam Family and Community Services, Inc. d/b/a CoveCare Center
Mr. Eric Toth, Chief Executive Officer
1808 Route Six, Carmel, NY 10512
Provider Number: 27700
Administrative Office:
Telephone - (845)-225-2700 Ext 246
Certificate Number: 211210952
1808 Route Six, Carmel, New York 10512
Effective: 09/04/2020 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Chemical Dependency Treatment Services
Service Type:
Program Name:
Certified Capacity:PRU 50422
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10952_Putnam.pdf
Q.S.A. Services Incorporated d/b/a The PAC Program of Queens
Ms. Jordania Estrella, Chief Operating Officer
40-11 Warren Street, Elmhurst, NY 11373
Provider Number: 44510
Administrative Office:
Telephone - (212)-837-2013
Certificate Number: 240511491
40-11 Warren Street, Elmhurst, New York 11373
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
The PAC Program
Service Type:
Program Name:
Certified Capacity:PRU 51997
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11491_QSASer.pdf
January 31, 2022 Page 162 of 227
The REACH Project, Inc.
Justine Waldman M.D., CEO
1001 W. Seneca Street, Ithaca, NY 14850
Provider Number: 51440
Administrative Office:
Telephone - (607)-273-7000
Certificate Number: 210712234
1st Floor, 1001 W. Seneca Street, , Ithaca, New York 14850
Effective: 03/05/2021 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53498
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12234_TheREA.pdf
Reality House, Inc.
Mr. Hewitt DePass, Executive Director
8-13 Astoria Boulevard, Astoria, NY 11102
Provider Number: 19660
Administrative Office:
Telephone - (212)-281-6004 Ext 302
Certificate Number: 220711685
8-13 Astoria Boulevard, Astoria, New York 11102
Effective: 05/29/2020 7/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52219
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11685_Realit.pdf
Certificate Number: 181211799
8-13 Astoria Boulevard, Astoria, New York 11102
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Reality House Veterans Community Residence
30Service Type:
Program Name:
Certified Capacity:PRU 52642
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11799_Realit.pdf
Realization Center, Inc.
Ms. Marilyn J. White, Executive Director and Chief Executive Officer
7th Floor, 19 Union Square West, New York, NY 10003
Provider Number: 27270
Administrative Office:
Telephone - (212)-627-9600
Certificate Number: 220210955
7th Floor, 19 Union Square West, New York, New York 10003
Effective: 11/19/2020 2/28/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Realization Center Clinic
Service Type:
Program Name:
Certified Capacity:PRU 7073
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10955_Realiz.pdf
January 31, 2022 Page 163 of 227
Certificate Number: 221011350
2nd Floor, 175 Remsen Street, Brooklyn, New York 11201
Effective: 11/01/2020 10/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7393
[with ancillary withdrawal services] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11350_Realiz.pdf
Recovery Associates of Upstate New York, Inc. as Sponsor, East House Corporation as Operator
Ms. Kim Brumber, President and Chief Executive Officer
Suite 200, 259 Monroe Avenue, Rochester, NY 14607
Provider Number: 50410
Administrative Office:
Telephone - (585)-238-4823
Certificate Number: 200210191
259 Monroe Avenue, Rochester, New York 14607
Effective: 01/03/2020 2/29/2020
Program Location:
Amendment Anticipated Recert Review:
Supportive Living (819)
Crossroads Apartment Program
72Service Type:
Program Name:
Certified Capacity:PRU 51260
with Telepractice Designation
and up to 12 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10191_Recove.pdf
Certificate Number: 200210192
109 Dartmouth Street, Rochester, New York 14607
Effective: 03/21/2019 2/29/2020
Program Location:
Establishment Anticipated Recert Review:
Community Residential (819)
Hirst House
12Service Type:
Program Name:
Certified Capacity:PRU 50038
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10192_Recove.pdf
Certificate Number: 200210193
561 Mount Hope Avenue, Rochester, New York 14620
Effective: 03/21/2019 2/29/2020
Program Location:
Establishment Anticipated Recert Review:
Community Residential (819)
Crossroads I, Hanson House
14Service Type:
Program Name:
Certified Capacity:PRU 50037
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10193_Recove.pdf
Certificate Number: 200210194
1st and 2nd Floors, Basement, 407 Frederick Douglass Street, Rochester, New York 14608
Effective: 03/21/2019 2/29/2020
Program Location:
Establishment Anticipated Recert Review:
Community Residential (819)
Crossroads III, Cody House
16Service Type:
Program Name:
Certified Capacity:PRU 50039
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10194_Recove.pdf
January 31, 2022 Page 164 of 227
Certificate Number: 200210195
50 Browncroft Boulevard, Rochester, New York 14609
Effective: 03/21/2019 2/29/2020
Program Location:
Establishment Anticipated Recert Review:
Community Residential (819)
Browncroft House
12Service Type:
Program Name:
Certified Capacity:PRU 51314
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10195_Recove.pdf
Regional Economic Community Action Program, Inc.
Mr. Charles Quinn, Chief Executive Officer
40 Smith Street, Middletown, NY 10940
Provider Number: 34070
Administrative Office:
Telephone - (845)-421-6243
Certificate Number: 190810116
Basement,, 1st & 2nd Floors, 127 Hickory Hill Road, Newburgh, New York 12550
Effective: 01/01/2018 8/31/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
RECAP - New Life Halfway House
24Service Type:
Program Name:
Certified Capacity:PRU 50196
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10116_Region.pdf
Certificate Number: 240611223
1st Floor, 40-48 Smith Street, Middletown, New York 10940
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50990
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11223_Region.pdf
Rego Park Counseling LLC
Mr Emanuil Kalendarev, Owner
1st Floor, 6336 99th Street, Rego Park, NY 11374
Provider Number: 51310
Administrative Office:
Telephone - (718)-496-3834
Certificate Number: 210112223
1st Floor, 6336 99th Street, , Rego Park, New York 11374
Effective: 08/21/2020 1/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 53489
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12223_RegoPa.pdf
Rehabilitation Support Services, Inc.
Mr. William DeVita, Executive Director
5172 Western Turnpike, Altamont, NY 12009
Provider Number: 14370
Administrative Office:
Telephone - (518)-464-1511
January 31, 2022 Page 165 of 227
Certificate Number: 181211313
Basement, 1st, 2nd & 3rd Floors, 11 Overbaugh Street, Saugerties, New York 12477
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Abel House
18Service Type:
Program Name:
Certified Capacity:PRU 51242
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11313_Rehabi.pdf
Renaissance Addiction Services, Inc.
Ms. Robin A. Clouden, Executive Director
920 Harlem Road, West Seneca, NY 14224
Provider Number: 48530
Administrative Office:
Telephone - (716)-827-9462
Certificate Number: 240911830
920 Harlem Road, West Seneca, New York 14224
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Rehabilitation Services for Youth (817)
Renaissance Addiction Services, Inc. (RASI)
47Service Type:
Program Name:
Certified Capacity:PRU 52733
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11830_Renais.pdf
Certificate Number: 220112164
920 Harlem Road, , West Seneca, New York 14224
Effective: 02/01/2021 1/31/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Promise House
15Service Type:
Program Name:
Certified Capacity:PRU 53536
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12164_Renais.pdf
Certificate Number: 220112179
920 Harlem Road, , West Seneca, New York 14224
Effective: 02/01/2021 1/31/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Palmerton Place
15Service Type:
Program Name:
Certified Capacity:PRU 53537
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Rensselaer County Department of Mental Health
Ms. Katherine Alonge-Coons, Commissioner
County Office Building, 3rd Floor, 1600 7th Avenue, Troy, NY 12180
Provider Number: 70300
Administrative Office:
Telephone - (518)-270-2807
Certificate Number: 230312013
Ned Pattison Rensselaer County Government Center, 3rd Floor, 1600 7th Avenue, Troy, New York 12180
Effective: 04/01/2020 3/31/2023
Program Location:
Renewal Anticipated Recert Review:
Prevention Counseling
Unified Services
Service Type:
Program Name:
Certified Capacity:PRU 90821
Algonquin Middle School, 1st Floor, Room 402, 333 NY Highway 351, Averill Park, NY 12018
Other Service Site(s) At:
Troy High School, 1950 Burdett Avenue, Troy, NY 12180
Other Service Site(s) At:
January 31, 2022 Page 166 of 227
Averill Park High School, 146 Gettle Road, Averill Park, NY 12018
Other Service Site(s) At:
Knickerbacker Middle/High School (Lansingburgh), 320 Seventh Avenue, Troy, NY 12182
Other Service Site(s) At:
Berlin Middle/High School, 17400 Route 22, Cherry Plain, NY 12040
Other Service Site(s) At:
Rensselaer City School District, 3rd Floor , Room 303, 25 Van Rensselaer Drive, Rensselaer, NY 12144
Other Service Site(s) At:
Columbia High School, 962 Luther Road, East Greenbush, NY 12061
Other Service Site(s) At:
Goff Middle School, Office, 35 Gilligan Road, East Greenbush, NY 12061
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12013_Rensse.pdf
Renwick Recovery, Inc.
Mr. Dominic P. Fata, Chief Executive Officer
131 Mill Street, Newburgh, NY 12550
Provider Number: 15510
Administrative Office:
Telephone - (845)-569-0775
Certificate Number: 181210335
131 Mill Street, Newburgh, New York 12550
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819) 40Service Type:
Program Name:
Certified Capacity:PRU 51584
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10335_Renwic.pdf
The Rescue Mission of Utica, N.Y.
Mr. James Haid, Chief Executive Officer
293 Genesee Street, Utica, NY 13501
Provider Number: 36280
Administrative Office:
Telephone - (315)-735-1645 Ext 101
Certificate Number: 221212078
210 Lansing Street, Utica, New York 13501
Effective: 01/01/2020 12/31/2022
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 25Service Type:
Program Name:
Certified Capacity:PRU 53101
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12078_TheRes.pdf
Resource Recovery Center of Orange County, LLC
Mr. Michael Bentson, Chief Executive Officer
68 Crystal Run Road, Middletown, NY 10941
Provider Number: 50790
Administrative Office:
Telephone - (845)-209-3512 Ext 7011
Certificate Number: 231012181
1st & 2nd Floors, 68 Crystal Run Road, , Middletown, New York 10941
Effective: 01/19/2021 10/31/2023
Program Location:
Amendment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 50Service Type:
Program Name:
Certified Capacity:PRU 53323
January 31, 2022 Page 167 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12181_Resour.pdf
Certificate Number: 231012182
1st Floor, 68 Crystal Run Road, , Middletown, New York 10941
Effective: 01/19/2021 10/31/2023
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 24Service Type:
Program Name:
Certified Capacity:PRU 53351
[up to 22 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12182_Resour.pdf
The Resource Training Center Inc.
Ms. AnnMarie Perrotto, President/CEO
3rd Floor, 4521 Arthur Kill Road, Staten Island, NY 10309
Provider Number: 46430
Administrative Office:
Telephone - (718)-605-1989 Ext 32
Certificate Number: 211011728
408 77th Street, , Brooklyn, New York 11209
Effective: 10/27/2021 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
d/b/a The Resource Counseling Center
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52554
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11728_Resour.pdf
Certificate Number: 220412144
3rd Floor, 4521 Arthur Kill Road, Staten Island, New York 10309
Effective: 05/01/2019 4/30/2022
Program Location:
Renewal Anticipated Recert Review:
d/b/a Christopher's Reason
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 53241
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12144_Resour.pdf
Restorative Management Corp.
Mr. Jeffrey Spitz LCSW, Executive Director
7 Railroad Avenue, Middletown, NY 10940
Provider Number: 1617
Administrative Office:
Telephone - (845)-561-5783
Certificate Number: 230110960
Floor 2, 7 Railroad Avenue, Middletown, New York 10940
Effective: 02/20/2020 1/31/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 6377
with Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10960_Restor.pdf
January 31, 2022 Page 168 of 227
Certificate Number: 230210961
172-178 Liberty Street, , Newburgh, New York 12550
Effective: 03/01/2020 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 7265
with Telepractice and Program Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10961_Restor.pdf
Certificate Number: 221211702
Suite #108, 123 Pike Street, , Port Jervis, New York 12771
Effective: 02/20/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52245
with Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11702_Restor.pdf
RevCore Recovery Center of Manhattan, LLC
Mr. Avraham Schick, Executive Director/CEO
181 Canal Street, New York, NY 10013
Provider Number: 49130
Administrative Office:
Telephone - (212)-966-9537
Certificate Number: 230211949
4th and 5th Floors, 181 Canal Street, New York, New York 10013
Effective: 03/01/2020 2/20/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52928
with Telepractice Designation
3rd Floor, 15 Second Avenue, Brooklyn, NY 11215
Additional Location(s) At:
Terence Cardinal Cooke Health Care Center (TCC), 4th Floor, Suite A-419, 1249 5th Avenue, New York, NY 10029
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11949_RevCor.pdf
Certificate Number: 230211950
3rd & 4th Floors, 37-20 74th Street, Jackson Heights, New York 11372
Effective: 03/01/2020 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52929
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11950_RevCor.pdf
Richmond Medical Center d/b/a Richmond University Medical Center
Mr. Daniel Messina, CEO
Active Parent Corporation: Bridge Regional Health System, Inc., 355 Bard Avenue, Staten Island, NY 10310
Provider Number: 45720
Administrative Office:
Telephone - (718)-818-2400
January 31, 2022 Page 169 of 227
Certificate Number: 240711634
Silberstein Center, 2nd Floor, 1130 South Avenue, , Staten Island, New York 10314
Effective: 7/31/2024
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Center for Young Adults
Service Type:
Program Name:
Certified Capacity:PRU 52125
with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]
Outpatient Service (822)
Center for Young Adults
Service Type:
Program Name:
Certified Capacity:PRU 53050
with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]
Outpatient Service (822)
Center for Young Adults
Service Type:
Program Name:
Certified Capacity:PRU 52125
with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]
Outpatient Service (822)
Center for Young Adults
Service Type:
Program Name:
Certified Capacity:PRU 53050
with Problem Gambling and Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11634_Richmo.pdf
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11634_Richmo.pdf
Certificate Number: 230312139
1st and 2nd Floors, 444 St. Mark's Place, Staten Island, New York 10301
Effective: 04/01/2020 3/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53235
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12139_Richmo.pdf
RISE Housing and Support Services, Inc.
Ms Sybil Newell M.A, Executive Director
127 Union Street, Saratoga Springs, NY 12866
Provider Number: 50590
Administrative Office:
Telephone - (518)-587-6193
Certificate Number: 190611645
994 Route 67, , Ballston Spa, New York 12020
Effective: 01/01/2018 6/30/2019
Program Location:
Amendment Anticipated Recert Review:
Supportive Living (819)
Hedgerow House Apartment Program
6Service Type:
Program Name:
Certified Capacity:PRU 51069
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11645_Transi.pdf
Certificate Number: 200112180
994 Route 67, , Ballston Spa, New York 12020
Effective: 02/19/2019 1/31/2020
Program Location:
Amendment Anticipated Recert Review:
Residential Services (820)
Hedgerow House
16Service Type:
Program Name:
Certified Capacity:PRU 53320
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
January 31, 2022 Page 170 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12180_RISEHo.pdf
RiseBoro Community Partnership
Mr. Scott Short, Chief Executive Officer
555 Bushwick Avenue, Brooklyn, NY 11206
Provider Number: 23470
Administrative Office:
Telephone - (718)-821-0254
Certificate Number: 240411984
5th Floor, 1474 Gates Avenue, Brooklyn, New York 11237
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90769
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11984_RiseBo.pdf
The Riverdale Mental Health Association, Inc.
Donna Demetri-Friedman Ph.D., Executive Director
5676 Riverdale Avenue, Bronx, NY 10471
Provider Number: 18040
Administrative Office:
Telephone - (718)-796-5300 Ext 145
Certificate Number: 200911355
Rooms #201 & #202, 2nd Floor, 5676 Riverdale Avenue, Bronx, New York 10471
Effective: 09/04/2020 9/30/2020
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 2016
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11355_Riverd.pdf
Riverhead Community Awareness Program, Inc.
Ms. Felicia Scocozza, Executive Director
Suite 106, 518 East Main Street, Riverhead, NY 11901
Provider Number: 2011
Administrative Office:
Telephone - (631)-727-3722 Ext 102
Certificate Number: 240812222
Administrative Offices, Suite 106, 518 East Main Street, , Riverhead, New York 11901
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention Counseling
Riverhead CAP
Service Type:
Program Name:
Certified Capacity:PRU 90638
with Telepractice Designation
Roanoke Elementary School, 2nd Floor, Room 208, 549 Roanoke Avenue, Riverhead, NY 11901
Other Service Site(s) At:
Riverhead Middle School, 2nd Floor, Room N-30, 600 Harrison Avenue, Riverhead, NY 11901
Other Service Site(s) At:
Riverhead High School, 2nd Floor, Room 205C, 700 Harrison Avenue, Riverhead, NY 11901
Other Service Site(s) At:
Phillips Avenue Elementary School, 1st Floor, Room 35, 141 Phillips Avenue, Riverhead, NY 11901
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12222_Riverh.pdf
The Rochester General Hospital
Ms. Jill Graziano, Vice President of Behavioral
1425 Portland Avenue, Rochester, NY 14621
Provider Number: 85320
Administrative Office:
Telephone - (585)-368-6931
January 31, 2022 Page 171 of 227
Certificate Number: 191111337
Hart Building, Rooms 70-72, 81-86 & E-7 (Offices), 1st Floor, 490 East Ridge Road, Rooms 19, 22A & B, 78, 80 (Group Space), Rochester, New York 14621
Effective: 01/01/2018 11/30/2019
Program Location:
Special ReIssue Anticipated Recert Review:Deemed
Outpatient Service (822)
Rochester Mental Health Center
Service Type:
Program Name:
Certified Capacity:PRU 50216
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11337_Roches.pdf
Rochester Regional Health as Active Parent and Co-Operator of Canton-Potsdam Hospital
Mr. David B. Acker, President - CEO
50 Leroy Street, Potsdam, NY 13676
Provider Number: 83110
Administrative Office:
Telephone - (315)-261-6003
Certificate Number: 211210698
12 Elm Street, , Potsdam, New York 13676
Effective: 01/01/2021 12/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51737
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10698_Roches.pdf
Certificate Number: 211211365
20 Cottage Street, , Potsdam, New York 13676
Effective: 01/01/2021 12/31/2021
Program Location:
Establishment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
Chemical Dependency Services
17Service Type:
Program Name:
Certified Capacity:PRU 51183
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11365_Roches.pdf
Rochester Regional Health as Active Parent and Co-Operator of Gouverneur Hospital
Mr. Eric R. Burch, CEO
77 West Barney Street, Gouverneur, NY 13642
Provider Number: 50540
Administrative Office:
Telephone - 315-261-6006
Certificate Number: 211212186
1500 Wing 1st Fl. 2300 Wi, 77 West Barney Street, , Gouverneur, New York 13642
Effective: 06/04/2021 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 53281
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12186_Roches.pdf
Rockville Centre Drug and Alcohol Abuse - CONFIDE, Inc.
Ms Wanda Florentino, Executive Director
Suite H-6, 30 Hempstead Avenue, Rockville Centre, NY 11570
Provider Number: 78
Administrative Office:
Telephone - (516)-764-5522
January 31, 2022 Page 172 of 227
Certificate Number: 230311534
Suites H-6, H-9 & H-12, Basement, 30 Hempstead Avenue, Rockville Centre, New York 11570
Effective: 09/21/2020 3/31/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 498
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11534_Rockvi.pdf
Rome Memorial Hospital, Inc.
Mark Murphy M.D., President/Chief Executive Officer
1500 North James Street, Rome, NY 13440
Provider Number: 81810
Administrative Office:
Telephone - (315)-338-7021
Certificate Number: 221210962
Liberty Plaza, 264 West Dominick Street, Rome, New York 13440
Effective: 05/13/2020 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Community Recovery Center
Service Type:
Program Name:
Certified Capacity:PRU 51124
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10962_RomeMe.pdf
Ruth M. Meyer d/b/a Community Counseling Services of Ronkonkoma
Ms. Ruth M. Meyer, Executive Director
Administrative Site, Suite E-14, 3281 Veterans Memorial Highway, Ronkonkoma, NY 11779
Provider Number: 12000
Administrative Office:
Telephone - (631)-471-3122
Certificate Number: 201211107
E14, 3281 Veterans Memorial Highway, Ronkonkoma, New York 11779
Effective: 09/04/2020 12/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51223
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11107_RuthMM.pdf
S.A.F.E. Foundation, Inc.
Mr. Ike Dweck, Chief Executive Officer
255 Avenue W, Brooklyn, NY 11223
Provider Number: 45700
Administrative Office:
Telephone - (866)-569-7233
Certificate Number: 230211635
255 Avenue W, Brooklyn, New York 11223
Effective: 08/25/2020 2/28/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
SAFE Foundation
Service Type:
Program Name:
Certified Capacity:PRU 52129
with Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11635_SAFEFo.pdf
Safe Harbor Retreat, LLC d/b/a The Dunes - East Hampton
Mr. Joseph McKinsey, Chief Executive Officer
201 Fort Pond Boulevard, East Hampton, NY 11937
Provider Number: 47650
Administrative Office:
Telephone - (631)-604-5405
January 31, 2022 Page 173 of 227
Certificate Number: 241211743
15 Lohan Court, , Southampton, New York 11968
Effective: 01/01/2022 12/31/2024
Program Location:
Renewal Anticipated Recert Review:
Community Residential (819) 16Service Type:
Program Name:
Certified Capacity:PRU 52571
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11743_SafeHa.pdf
Certificate Number: 220911815
201 Fort Pond Boulevard, East Hampton, New York 11937
Effective: 10/28/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
The Dunes
Service Type:
Program Name:
Certified Capacity:PRU 52720
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11815_SafeHa.pdf
Saint Regis Mohawk Tribe/ Saint Regis Mohawk Health Services
Mr. Michael Cook, Executive Director
Health and Human Services Division, 404 State Route 37, Akwesasne, NY 13655
Provider Number: 22290
Administrative Office:
Telephone - (518)-358-3141
Certificate Number: 201010963
404 State Route 37, , Akwasasne, New York 13655
Effective: 08/21/2020 10/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Alcohol/Chemical Dependency Program
Service Type:
Program Name:
Certified Capacity:PRU 5266
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10963_SaintR.pdf
Certificate Number: 210211393
Partridge House, 25 St. Regis Road, Hogansburg, New York 13655
Effective: 03/01/2018 2/28/2021
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 16Service Type:
Program Name:
Certified Capacity:PRU 50779
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11393_SaintR.pdf
The Salvation Army
Major John Haggerty, Chief Executive Director
Elmira Citadel, 414 Lake Street, Elmira, NY 14901
Provider Number: 37020
Administrative Office:
Telephone - (607)-732-0314
Certificate Number: 181210156
Basement, 1st & 2nd Flrs., 401-403 Division Street, Elmira, New York 14901
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Elmira Citadel
25Service Type:
Program Name:
Certified Capacity:PRU 50470
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10156_Salvat.pdf
January 31, 2022 Page 174 of 227
Samaritan Daytop Village, Inc.
Mr. Mitchell Netburn, President and Chief Executive Officer
Administrative Headquarters, 13802 Queens Boulevard, Jamaica, NY 11435
Provider Number: 16890
Administrative Office:
Telephone - (718)-206-2000 Ext 1200
Certificate Number: 181210038
1381 Dr. Martin Luther King Jr Blvd, Bronx, New York 10452
Effective: 01/01/2018 12/31/2018
Program Location:
Conditional Certificate Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 60Service Type:
Program Name:
Certified Capacity:PRU 3162
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10038_Samari.pdf
Certificate Number: 181210040
(Residence), 327 West 43rd Street, 8th Floor, (Counseling), 321 West 44th Street, New York, New York 10036
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 48Service Type:
Program Name:
Certified Capacity:PRU 6974
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10040_Samari.pdf
Certificate Number: 200510352
130-20 89th Road, , Richmond Hill, New York 11418
Effective: 04/29/2019 5/31/2020
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 150Service Type:
Program Name:
Certified Capacity:PRU 52532
[with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10352_Samari.pdf
Certificate Number: 210811278
144-10 Jamaica Avenue, , Jamaica, New York 11435
Effective: 08/23/2021 8/31/2021
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 6595
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53550
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11278_Samari.pdf
Certificate Number: 181211594
130-15 89th Road, Richmond Hill, New York 11418
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Richmond Hill Veterans Program
50Service Type:
Program Name:
Certified Capacity:PRU 52067
January 31, 2022 Page 175 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11594_Samari.pdf
Certificate Number: 181211750
Floors 1 - 3, 751 Briggs Highway, Ellenville, New York 12428
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819)
Women Veterans Program
25Service Type:
Program Name:
Certified Capacity:PRU 52579
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11750_Samari.pdf
Certificate Number: 181211827
Basement, 1st-4th Floors, 68 West 106th Street, New York, New York 10025
Effective: 01/01/2018 12/31/2018
Program Location:
Conditional Certificate Anticipated Recert Review:
Community Residential (819) 36Service Type:
Program Name:
Certified Capacity:PRU 52722
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11827_Samari.pdf
Certificate Number: 181211828
119 West 106th Street, New York, New York 10025
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 36Service Type:
Program Name:
Certified Capacity:PRU 52723
and up to 30 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11828_Samari.pdf
Certificate Number: 220311829
7th Floor, 2090 Adam Clayton Powell, Jr. Blvd., , New York, New York 10027
Effective: 08/05/2019 3/31/2022
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Samaritan Daytop Village/Harlem Outpatient
0Service Type:
Program Name:
Certified Capacity:PRU 52724
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11829_Samari.pdf
Certificate Number: 220611915
1st Floor, 250 Grand Concourse, , Bronx, New York 10451
Effective: 04/16/2021 6/30/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 770Service Type:
Program Name:
Certified Capacity:PRU 52883
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11915_Samari.pdf
January 31, 2022 Page 176 of 227
Certificate Number: 220611916
1st & 2nd Floors, 362 East 148th Street, , Bronx, New York 10455
Effective: 11/15/2021 6/30/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Mott Haven OTP
850Service Type:
Program Name:
Certified Capacity:PRU 52882
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11916_Samari.pdf
Certificate Number: 210811937
5th Floor, 362 East 148th Street, , Bronx, New York 10455
Effective: 08/23/2021 8/31/2021
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52897
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11937_Samari.pdf
Certificate Number: 220211943
338 Forbell Street, , Brooklyn, New York 11208
Effective: 11/25/2019 2/28/2022
Program Location:
Conditional Certificate Anticipated Recert Review:OASAS Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52916
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MH 0Service Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11943_Samari.pdf
Certificate Number: 220411956
1st & 2nd Floors, 620 Route 303, Blauvelt, New York 10913
Effective: 05/01/2019 4/1/2022
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Rockland Outreach Center
0Service Type:
Program Name:
Certified Capacity:PRU 52930
with Telepractice Designation [with ancillary withdrawal services]
Outpatient Rehabilitation Service (822)
Rockland Outreach Center
Service Type:
Program Name:
Certified Capacity:PRU 53103
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11956_Samari.pdf
January 31, 2022 Page 177 of 227
Certificate Number: 220311957
900 Arnow Avenue, Bronx, New York 10469
Effective: 04/01/2019 3/31/2022
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Bronx Outreach Center
0Service Type:
Program Name:
Certified Capacity:PRU 52769
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11957_Samari.pdf
Certificate Number: 231111958
2075 New York Avenue, Huntington Station, New York 11746
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Suffolk Outreach Center
0Service Type:
Program Name:
Certified Capacity:PRU 52931
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11958_Samari.pdf
Certificate Number: 220211960
Basement & 1st Floor, 1915 Forest Avenue, Staten Island, New York 10303
Effective: 03/01/2019 2/28/2022
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)
Staten Island Outreach Center
0Service Type:
Program Name:
Certified Capacity:PRU 52771
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11960_Samari.pdf
Certificate Number: 240212120
767 Cape Road, Ellenville, New York 12428
Effective: 03/01/2021 2/28/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 80Service Type:
Program Name:
Certified Capacity:PRU 53118
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12120_Samari.pdf
January 31, 2022 Page 178 of 227
Certificate Number: 231012226
751 Briggs Highway, , Ellenville, New York 12428
Effective: 11/01/2021 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 135Service Type:
Program Name:
Certified Capacity:PRU 53460
[Men's Dorm - 105 beds, Women's Dorm - 30 beds]
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12226_Samari.pdf
Certificate Number: 231012238
Buildings #4, 10, 11, 15 , 88 Fox Hollow Road, , Rhinebeck, New York 12572
Effective: 11/01/2021 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Meadow Run Female Program SRR
56Service Type:
Program Name:
Certified Capacity:PRU 53512
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12238_Samari.pdf
Certificate Number: 211012239
190 Fox Hollow Road, , Rhinebeck, New York 12572
Effective: 11/02/2020 10/31/2021
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820)
Fox Run Male Program
92Service Type:
Program Name:
Certified Capacity:PRU 53513
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 220912286
88-83 Van Wyck Expressway, , Jamaica, New York 11435
Effective: 10/01/2021 9/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820) 96Service Type:
Program Name:
Certified Capacity:PRU 53586
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12286_Samari.pdf
Certificate Number: 220912287
130-20 89th Road, , Richmond Hill, New York 11418
Effective: 10/01/2021 9/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820) 104Service Type:
Program Name:
Certified Capacity:PRU 53515
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12287_Samari.pdf
Samaritan Medical Center
Mr. Thomas Carman, Chief Executive Officer
830 Washington Street, Watertown, NY 13601
Provider Number: 15920
Administrative Office:
Telephone - (315)-785-4000
January 31, 2022 Page 179 of 227
Certificate Number: 220310969
1st Floor, 1575 Washington Street, Watertown, New York 13601
Effective: 07/01/2020 3/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Samaritan Medical Center Addiction Services
Service Type:
Program Name:
Certified Capacity:PRU 51705
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10969_Samari.pdf
Saratoga County Community Services Board
Michael S. Prezioso Ph.D., CommissionerServices
135 South Broadway, Saratoga Springs, NY 12866
Provider Number: 70840
Administrative Office:
Telephone - (518)-584-9030 Ext 1020
Certificate Number: 201010971
135 South Broadway, , Saratoga Springs, New York 12866
Effective: 07/10/2020 10/31/2020
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)
Saratoga County Alcohol & Substance Abuse Services
Service Type:
Program Name:
Certified Capacity:PRU 50759
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10971_Sarato.pdf
The Saratoga Hospital
Mr. Angelo G. Calbone, President/CEO
1st Floor, 211 Church Street, Saratoga Springs, NY 12866
Provider Number: 87070
Administrative Office:
Telephone - (518)-587-3222
Certificate Number: 220712152
1st Floor, 24 Hamilton Street, Saratoga Springs, New York 12866
Effective: 09/21/2020 7/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Saratoga Community Health Center's Addiction Medicine Program
Service Type:
Program Name:
Certified Capacity:PRU 53269
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12152_Sarato.pdf
SCAN-New York Volunteer Parent-Aides Association, Inc.
Mr. Lewis Zuchman, Executive Director
Suite 301, 345 East 102nd Street, New York, NY 10029
Provider Number: 2035
Administrative Office:
Telephone - (212)-289-8030
Certificate Number: 210211338
Basement & 1st Floor, 1377 Jerome Avenue, Bronx, New York 10452
Effective: 03/01/2018 2/28/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7422
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11338_SCANNe.pdf
Schenectady Family Health Services, Inc. d/b/a Hometown Health Centers
Mr. Joseph Gambino, Chief Executive Officer
1044 State Street, Schenectady, NY 12307
Provider Number: 51390
Administrative Office:
Telephone - (518)-370-1441 Ext 4126
January 31, 2022 Page 180 of 227
Certificate Number: 211212252
1044 State Street, , Schenectady, New York 12307
Effective: 01/04/2021 12/31/2021
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)
Hometown Health Centers
Service Type:
Program Name:
Certified Capacity:PRU 53493
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12252_Schene.pdf
Schoharie County Community Services Board
Ms. Bonnie L. Post, Director of Community Services
County Annex Building, Suite #1, 113 Park Place, PO Box 160, Schoharie, NY 12157
Provider Number: 70740
Administrative Office:
Telephone - (518)-295-8407
Certificate Number: 240510972
Schoharie County Annex Building, Suite #1, 113 Park Place, Schoharie, New York 12157
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Schoharie County Chemical Dependencies Clinic
Service Type:
Program Name:
Certified Capacity:PRU 50427
with Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10972_Schoha.pdf
SCO Family of Services
Mr. Keith Little, Executive Director
1 Alexander Place, Glen Cove, NY 11542
Provider Number: 22270
Administrative Office:
Telephone - (516)-671-1253
Certificate Number: 240312177
2nd Floor, 151 Burrs Lane, , Dix Hills, New York 11746
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Morning Star I
20Service Type:
Program Name:
Certified Capacity:PRU 53316
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Certificate Number: 240312178
Freestanding Building - 1st Floor, Main Building - 2nd Floor, Morning Star II Expansion, 151 Burrs Lane, , Dix Hills, New York 11746
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Morning Star II
23Service Type:
Program Name:
Certified Capacity:PRU 53317
and up to 25 beds for childrenElements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12178_SCOFam.pdf
Certificate Number: 220712272
151 Burrs Lane, , Dix Hills, New York 11746
Effective: 08/23/2021 7/31/2022
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53029
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12272_SCOFam.pdf
January 31, 2022 Page 181 of 227
Certificate Number: 221012292
1 Alexander Place , , Glen Cove, New York 11542
Effective: 11/10/2021 10/31/2022
Program Location:
Establishment Anticipated Recert Review:
Community Psychiatric Support & Treatment (CPST)Service Type:
Program Name:
Certified Capacity:PRU 53605
Other Licensed PractitionersService Type:
Program Name:
Certified Capacity:PRU 53604
Psychosocial Rehabilitation (PSR)Service Type:
Program Name:
Certified Capacity:PRU 53603
Family Peer Support and ServicesService Type:
Program Name:
Certified Capacity:PRU 53601
Youth Peer Support and TrainingService Type:
Program Name:
Certified Capacity:PRU 53602
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12292_SCOFam
Seafield Center, Inc.
Mr. Mark Epley, CEO
7 Seafield Lane, Westhampton Beach, NY 11978
Provider Number: 18990
Administrative Office:
Telephone - (631)-288-1122 Ext 204
Certificate Number: 220411395
1st and 2nd Floors, 7 Seafield Lane, Westhampton Beach, New York 11978
Effective: 03/01/2021 4/30/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 100Service Type:
Program Name:
Certified Capacity:PRU 50893
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11395_Seafie.pdf
Seafield Services, Inc.
Mr. Mark Epley, Chief Executive Officer
7 Seafield Lane, Westhampton Beach, NY 11978
Provider Number: 17440
Administrative Office:
Telephone - (631)-288-1122
Certificate Number: 201110581
240 West Main Street, , Riverhead, New York 11901
Effective: 07/01/2020 11/30/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Seafield Riverhead
Service Type:
Program Name:
Certified Capacity:PRU 5830
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10581_Seafie.pdf
January 31, 2022 Page 182 of 227
Certificate Number: 221110582
1st & 2nd Floors, 37 John Street, Amityville, New York 11701
Effective: 07/01/2020 11/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Seafield Amityville
Service Type:
Program Name:
Certified Capacity:PRU 50895
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52961
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10582_Seafie.pdf
Certificate Number: 210910583
Basement, 1st and 2nd Floors, 110 Main Street, Mineola, New York 11501
Effective: 07/01/2020 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Seafield Mineola
Service Type:
Program Name:
Certified Capacity:PRU 51109
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10583_Seafie.pdf
Certificate Number: 231110977
Suite 101, 1st Floor, 475 East Main Street, East Patchogue, New York 11772
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Seafield Patchogue
Service Type:
Program Name:
Certified Capacity:PRU 7246
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10977_Seafie.pdf
Certificate Number: 231010978
Bldg. 9, 3251 Route 112, Medford, New York 11763
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Seafield Medford
Service Type:
Program Name:
Certified Capacity:PRU 51806
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10978_Seafie.pdf
Seneca County Community Services Board
Ms. Margaret Morse, Director of Community Services
31 Thurber Drive, Waterloo, NY 13165
Provider Number: 70330
Administrative Office:
Telephone - (315)-539-1985
Certificate Number: 231010984
31 Thurber Drive, Waterloo, New York 13165
Effective: 11/01/2020 10/31/2023
Program Location:
Renewal Anticipated Recert Review:OMH Host
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50431
with Problem Gambling Designation [with ancillary withdrawal services] with Telepractice Designation
January 31, 2022 Page 183 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10984_Seneca.pdf
Certificate Number: 240811986
31 Thurber Drive, Waterloo, New York 13165
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90731
with Telepractice Designation
Waterloo High School, 96 Stark Street, Waterloo, NY 13165
Other Service Site(s) At:
Waterloo Middle School, 65 Center Street, Waterloo, NY 13165
Other Service Site(s) At:
Mynderse Academy High School, 1st Floor, Room 150A, 105 Troy Street, Seneca Falls, NY 13148
Other Service Site(s) At:
South Seneca Middle/High School, 2nd Floor, North, Rooms W & M, 7263 Main Street, Ovid, NY 14521
Other Service Site(s) At:
Cady Stanton Elementary School, 1st Floor, Room 13, 38 Garden Street, Seneca Falls, NY 13148
Other Service Site(s) At:
Frank Knight Elementary School, 1st Floor, Room 42, 98 Clinton Street, Seneca Falls, NY 13148
Other Service Site(s) At:
Seneca Falls Middle School, 1st Floor, Conference Room, 95 Troy Street, Seneca Falls, NY 13148
Other Service Site(s) At:
Romulus Central School, 1st Floor, Room 40, 5705 Main Street, Romulus, NY 14541
Other Service Site(s) At:
La Fayette Elementary School, 2nd Floor, Room Adjacent to Room 211, 71 Inslee Street, Waterloo, NY 13165
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11986_Seneca.pdf
Senior Hope Counseling, Inc.
Nicole MacFarland Ph.D., Executive Director
2nd Floor, 650 Warren Street, Albany, NY 12208
Provider Number: 45240
Administrative Office:
Telephone - (518)-489-7777 Ext 102
Certificate Number: 221111589
2nd Floor, 650 Warren Street, , Albany, New York 12208
Effective: 12/01/2020 11/30/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52134
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11589_Senior.pdf
Services for the Underserved, Inc. as Sponsor Palladia, Inc. as Operator
Ms. Donna Colonna, President and Chief Executive Officer
Palladia, Inc. as Operator, 17th Floor, 463 7th Avenue, New York, NY 10018
Provider Number: 39050
Administrative Office:
Telephone - (212)-633-6900
January 31, 2022 Page 184 of 227
Certificate Number: 211011885
2nd Floor, 177-185 East 122nd Street, New York, New York 10035
Effective: 11/01/2019 10/31/2021
Program Location:
Renewal Anticipated Recert Review:OASAS Host
Outpatient Service (822)
CTI Harlem
Service Type:
Program Name:
Certified Capacity:PRU 52857
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
1366 Inwood Avenue, Bronx, NY 10452
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11885_Servic.pdf
Certificate Number: 221112293
Basement-5th Floors, 1806-08 Third Avenue , , New York, New York 10029
Effective: 12/14/2021 11/30/2022
Program Location:
Establishment Anticipated Recert Review:
Residential Services (820) 72Service Type:
Program Name:
Certified Capacity:PRU 53609
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12293_Service.pdf
SES Operating Corp. d/b/a Harlem East Life Plan
Mr. Stuart R. Steiner, President, Executive Director
2369 Second Avenue, New York, NY 10035
Provider Number: 550
Administrative Office:
Telephone - (212)-876-2300 Ext 102
Certificate Number: 221010384
1st & 2nd Floors, 2369 Second Avenue, , New York, New York 10035
Effective: 07/03/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 500Service Type:
Program Name:
Certified Capacity:PRU 1474
with Telepractice Designation [with ancillary withdrawal services for up to 50 patients]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10384_SESOpe.pdf
Certificate Number: 221010385
1st & 2nd Floors, 2369 Second Avenue, , New York, New York 10035
Effective: 07/03/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 50Service Type:
Program Name:
Certified Capacity:PRU 7340
with Telepractice Designation - 50 of which are Key Extended Entry Program (KEEP) Patients [with ancillary withdrawal services for up to 50 patients]
Opioid Treatment Program (822) 500Service Type:
Program Name:
Certified Capacity:PRU 1473
with Telepractice Designation - 50 of which are Key Extended Entry Program (KEEP) Patients [with ancillary withdrawal services for up to 50 patients]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10385_SESOpe.pdf
January 31, 2022 Page 185 of 227
Certificate Number: 211211292
2369 Second Avenue, 3rd Floor, 2367 Second Avenue, 1st Floor, New York, New York 10035
Effective: 07/03/2020 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Harlem East Life Plan (HELP)
0Service Type:
Program Name:
Certified Capacity:PRU 51840
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11292_SESOpe.pdf
Shiloh Psychological Consulting PLLC
Kay Jackson Ph.D., Executive Director/Owner
4th Floor, 566 Seventh Avenue, New York, NY 10018
Provider Number: 50550
Administrative Office:
Telephone - 212-564-7631
Certificate Number: 200212160
4th Floor, 566 Seventh Avenue, , New York, New York 10018
Effective: 03/01/2019 2/29/2020
Program Location:
Establishment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53293
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Silver Lake Support Services, Inc.
Mr. Avraham Schick, Executive Director
201 Forest Avenue, Staten Island, NY 10301
Provider Number: 41860
Administrative Office:
Telephone - (718)-815-3155
Certificate Number: 220710987
1st & 2nd Floors, 201 Forest Avenue, , Staten Island, New York 10301
Effective: 08/22/2019 7/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 51829
with Telepractice Designation
1st Floor, 797 Brighton Avenue, Staten Island, NY 10301
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10987_Silver.pdf
Sisters of Charity Hospital of Buffalo, New York
Ms. Heather Loomis, VP Operations
2157 Main Street, Buffalo, NY 14214
Provider Number: 81820
Administrative Office:
Telephone - (716)-862-2378
Certificate Number: 210610408
158 Holden Street, , Buffalo, New York 14214
Effective: 07/31/2020 6/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 650Service Type:
Program Name:
Certified Capacity:PRU 409
with Telepractice Designation
Capacity Lifted
Opioid Medical Maintenance (822)Service Type:
Program Name:
Certified Capacity:PRU 7347
January 31, 2022 Page 186 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10408_Sister.pdf
Certificate Number: 210710409
1st Floor, 435 East Henrietta Road, , Rochester, New York 14620
Effective: 07/22/2020 7/20/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Treatment Program (822) 250Service Type:
Program Name:
Certified Capacity:PRU 6924
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10409_Sister.pdf
Certificate Number: 220310988
1st Floor, 210 John Glenn Drive, , Amherst, New York 14228
Effective: 07/10/2020 3/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Sisters Health Center Amherst
Service Type:
Program Name:
Certified Capacity:PRU 51018
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10988_Sister.pdf
Certificate Number: 210610992
1500 Broadway, Buffalo, New York 14212
Effective: 07/01/2018 6/30/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
STAR (Substance Treatment and Recovery) St. Vincent
Service Type:
Program Name:
Certified Capacity:PRU 51564
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10992_Sister.pdf
Certificate Number: 210912158
1st Floor, 210 John Glenn Drive, , Amherst, New York 14228
Effective: 08/10/2021 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Sisters Health Center Amherst
250Service Type:
Program Name:
Certified Capacity:PRU 53282
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12158_Sister.pdf
South Brooklyn Medical Administrative Services, Inc.
Ms. Alexis Bosco, Administrator & Chief Executive Officer
685 Third Avenue, Brooklyn, NY 11232
Provider Number: 553
Administrative Office:
Telephone - (718)-788-2594 Ext 117
Certificate Number: 221210387
685 3rd Avenue, Brooklyn, New York 11232
Effective: 01/01/2020 12/31/2022
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 450Service Type:
Program Name:
Certified Capacity:PRU 1479
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10387_SouthB.pdf
January 31, 2022 Page 187 of 227
South Richmond Hill Recovery, LLC
Mr. John J. Saith, Program Director
88-08 Liberty Avenue, Ozone Park, NY 11417
Provider Number: 49820
Administrative Office:
Telephone - (718)-785-3380 Ext 101
Certificate Number: 230212114
88-08 Liberty Avenue, , Ozone Park, New York 11417
Effective: 09/09/2020 2/28/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53167
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12114_SouthR.pdf
Southeast Nassau Guidance Center, Inc.
Milton Kalin Ph.D., Chief Executive Officer
2146 Jackson Avenue, P.O. Box 1037, Seaford, NY 11783
Provider Number: 50150
Administrative Office:
Telephone - (516)-679-9800
Certificate Number: 240710994
2nd Floor, 3375 Park Avenue, Wantagh, New York 11793
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 446
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10994_Southe.pdf
Certificate Number: 211110995
1st & 2nd Floor, 2146 Jackson Avenue, , Seaford, New York 11783
Effective: 06/22/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Chemical Dependence Counseling and Treatment
Service Type:
Program Name:
Certified Capacity:PRU 50473
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10995_Southe.pdf
Sports Foundation, Inc.
Akinshey X. Dorsett, Executive Director
871 Westchester Avenue, Bronx, NY 10459
Provider Number: 1613
Administrative Office:
Telephone - (718)-665-9585
Certificate Number: 200611975
Basement, 1st Floor Lobby, 871 Westchester Avenue, Bronx, New York 10459
Effective: 07/01/2018 6/30/2020
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90748
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11975_Sports.pdf
St. Barnabas Hospital
David Perlstein M.D., President and Chief Executive Officer
Administration - Braker Building, 4421 Third Avenue, Bronx, NY 10457
Provider Number: 81630
Administrative Office:
Telephone - (718)-960-6561
January 31, 2022 Page 188 of 227
Certificate Number: 220610234
Main Building, 4th Floor, 4422 Third Avenue, Bronx, New York 10457
Effective: 10/19/2020 6/30/2022
Program Location:
Amendment Anticipated Recert Review:
Medically Managed Withdrawal & Stabilization Services (816.6) 24Service Type:
Program Name:
Certified Capacity:PRU 50717
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10234_StBarn.pdf
Certificate Number: 231110406
4535 Third Avenue, , Bronx, New York 10458
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 660Service Type:
Program Name:
Certified Capacity:PRU 6962
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10406_StBarn.pdf
Certificate Number: 211010997
2nd floor, 4441-4451 Third Avenue, Bronx, New York 10457
Effective: 07/03/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50718
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10997_StBarn.pdf
St. Charles Hospital, Port Jefferson, New York
Mr. James O'Connor, Executive Vice President and CEO
1st Floor, 200 Belle Terre Road, Port Jefferson, NY 11777
Provider Number: 82100
Administrative Office:
Telephone - (631)-474-6105
Certificate Number: 211111398
5 North and 5 South, 5th Floor, 200 Belle Terre Road, , Port Jefferson, New York 11777
Effective: 01/09/2019 11/17/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818) 40Service Type:
Program Name:
Certified Capacity:PRU 51415
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11398_StChar.pdf
Certificate Number: 211111839
2 North, 2nd Floor, 200 Belle Terre Road, , Port Jeffferson, New York 11777
Effective: 01/09/2019 11/17/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 20Service Type:
Program Name:
Certified Capacity:PRU 52754
[with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11839_StChar.pdf
January 31, 2022 Page 189 of 227
Certificate Number: 211111844
3 West, 3rd Floor, 200 Belle Terre Road, Port Jefferson, New York 11777
Effective: 01/09/2019 11/17/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 4Service Type:
Program Name:
Certified Capacity:PRU 52762
(adolescent) [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11844_StChar.pdf
St. Christopher's Inn, Inc.
James Schiller Ph.D., Executive Director
Box 150, 21 Franciscan Way, Garrison, NY 10524
Provider Number: 25360
Administrative Office:
Telephone - (845)-335-1009
Certificate Number: 240710564
21 Franciscan Way, Garrison, New York 10524
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51663
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51900
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10564_StChri.pdf
Certificate Number: 240811243
21 Franciscan Way, Garrison, New York 10524
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Outpatient Withdrawal & Stabilization (816.8)
St. Christopher's Inn
10Service Type:
Program Name:
Certified Capacity:PRU 8053
[without the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11243_StChri.pdf
Certificate Number: 231212183
13 Longview Avenue, , White Plains, New York 10605
Effective: 01/01/2021 12/31/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Brothers Christopher House
11Service Type:
Program Name:
Certified Capacity:PRU 53324
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12183_StChri.pdf
St. John's Riverside Hospital, Inc.
Mr. Ronald J. Corti, President and CEO
Andrus Pavilion, 967 North Broadway, Yonkers, NY 10701
Provider Number: 87150
Administrative Office:
Telephone - (914)-964-4221
January 31, 2022 Page 190 of 227
Certificate Number: 231211245
Wellness Center & Lab, 1st Floor, 2 Park Avenue, Yonkers, New York 10703
Effective: 03/07/2021 12/31/2023
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 400Service Type:
Program Name:
Certified Capacity:PRU 401
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11245_StJohn.pdf
Certificate Number: 220111247
North Wing, 3rd & 6th Floors North, 2 Park Avenue, Yonkers, New York 10703
Effective: 02/01/2019 1/31/2022
Program Location:
Renewal Anticipated Recert Review:
Medically Managed Withdrawal & Stabilization Services (816.6) 72Service Type:
Program Name:
Certified Capacity:PRU 50820
- with the use of methadone
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11247_StJohn.pdf
Certificate Number: 210711281
2nd Floor, 2 Park Avenue, Yonkers, New York 10703
Effective: 09/04/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
New Focus Center
Service Type:
Program Name:
Certified Capacity:PRU 51378
with Telepractice Designation
Outpatient Rehabilitation Service (822)
New Focus Center
Service Type:
Program Name:
Certified Capacity:PRU 51945
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11281_StJohn.pdf
Certificate Number: 240711283
1st Floor, 30 Manhattan Avenue, White Plains, New York 10607
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Greenburgh ATS
Service Type:
Program Name:
Certified Capacity:PRU 51687
with Telepractice Designation
Outpatient Rehabilitation Service (822)
Greenburgh ATS
Service Type:
Program Name:
Certified Capacity:PRU 51944
with Telepractice Designation
Westhab-Coachman Family Center, 1-1/2 Main Mezzanine, 123 East Post Road, White Plains, NY 10601
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11283_StJohn.pdf
January 31, 2022 Page 191 of 227
Certificate Number: 240611284
1st Floor, 20 East First Street, Mount Vernon, New York 10550
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50638
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51947
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11284_StJohn.pdf
Certificate Number: 220111401
3rd Floor, West Wing, 5th Floor, North Wing, 3rd Floor, East Wing, 2 Park Avenue, Yonkers, New York 10703
Effective: 02/01/2019 1/31/2022
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 69Service Type:
Program Name:
Certified Capacity:PRU 51609
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11401_StJohn.pdf
St. Joseph’s Rehabilitation Center, Inc.
Mr. Robert Ross, Chief Executive Officer/President
159 Glenwood Drive, Saranac Lake, NY 12983
Provider Number: 35160
Administrative Office:
Telephone - (518)-891-3310 Ext 242
Certificate Number: 220210130
Building #1, and Family Building, 1st, 2nd & 3rd Floors, & 50 John Munn Road, 159 Glenwood Drive, , Saranac Lake, New York 12983
Effective: 10/19/2021 2/15/2022
Program Location:
Emergency Anticipated Recert Review:
d/b/a St. Joseph's Addiction Treatment and Recovery Centers
Inpatient Rehabilitation Service ( 818)
Chemical Dependence Rehabilitation
67Service Type:
Program Name:
Certified Capacity:PRU 50169
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10130_StJose.pdf
Certificate Number: 181210131
7 Fallkill Place, Poughkeepsie, New York 12601
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
d/b/a St. Joseph's Addiction Treatment and Recovery Centers
Supportive Living (819) 12Service Type:
Program Name:
Certified Capacity:PRU 51646
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10131_StJose.pdf
January 31, 2022 Page 192 of 227
Certificate Number: 231011003
50 John Munn Road , , Saranac Lake, New York 12983
Effective: 11/09/2021 10/31/2023
Program Location:
Amendment Anticipated Recert Review:
d/b/a St. Joseph's Addiction Treatment and Recovery Centers
Outpatient Service (822)
Robert R. Reiss Community Services Center
Service Type:
Program Name:
Certified Capacity:PRU 50171
with Telepractice and Problem Gambling Designations
386 River Road, Lake Placid, NY 12946
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11003_StJose.pdf
Certificate Number: 211011004
458 East Main Street, Malone, New York 12953
Effective: 10/21/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
d/b/a St. Joseph's Addiction Treatment and Recovery Centers
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50170
with Telepractice and Problem Gambling Designations
Bushnell Medical Building, 17 Hospital Drive, Massena, NY 13662
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11004_StJose.pdf
Certificate Number: 210111005
1st & 2nd Floors, 50 Montcalm Street, Ticonderoga, New York 12883
Effective: 04/16/2020 1/31/2021
Program Location:
Amendment Anticipated Recert Review:
d/b/a St. Joseph's Addiction Treatment and Recovery Centers
Outpatient Service (822)
Ticonderoga Chemical Dependence Outpatient Clinic
0Service Type:
Program Name:
Certified Capacity:PRU 50173
with Telepractice and Problem Gambling Designations
7520 Court Street, Elizabethtown, NY 12932
Additional Location(s) At:
1st Floor, 1703 Front Street, Keeseville, NY 12944
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11005_StJose.pdf
Certificate Number: 240512052
Floors 1-2, 444 Kiwassa Lake Road, Saranac Lake, New York 12983
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
d/b/a St. Joseph's Addiction Treatment and Recovery Centers
Residential Services (820)
Col. C. David Merkel, MD Veterans Residential Program
25Service Type:
Program Name:
Certified Capacity:PRU 53046
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12052_StJose.pdf
January 31, 2022 Page 193 of 227
Certificate Number: 240212067
100 County Route 43, Massena, New York 13662
Effective: 03/01/2021 2/29/2024
Program Location:
Renewal Anticipated Recert Review:
d/b/a Rose Hill
Residential Rehabilitation Services for Youth (817)
Rose Hill
Service Type:
Program Name:
Certified Capacity:PRU 53062
-- Rose Hill Young Adult Program 14 Beds -- Rose Hill Adolescent Program 14 Beds with Telepractice Designation
Residential Rehabilitation Services for Youth (817)
Rose Hill
28Service Type:
Program Name:
Certified Capacity:PRU 53063
-- Rose Hill Young Adult Program 14 Beds -- Rose Hill Adolescent Program 14 Beds with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12067_StJose.pdf
Certificate Number: 221112271
50 John Munn Road, , Saranac Lake, New York 12983
Effective: 12/29/2021 11/30/2022
Program Location:
Establishment Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
Robert R. Reiss Community Services Center
10Service Type:
Program Name:
Certified Capacity:PRU 53570
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
St. Joseph's Hospital, Yonkers
Mr. Michael J. Spicer, President & CEO
127 South Broadway, Yonkers, NY 10701
Provider Number: 81050
Administrative Office:
Telephone - (914)-378-7485
Certificate Number: 210310399
1st Floor, 317 South Broadway, Yonkers, New York 10705
Effective: 04/01/2018 3/31/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Opioid Treatment Program (822) 500Service Type:
Program Name:
Certified Capacity:PRU 400
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10399_StJose.pdf
Certificate Number: 210710633
2nd Floor, 317 South Broadway, Yonkers, New York 10705
Effective: 09/25/2019 7/28/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)
Positive Directions
0Service Type:
Program Name:
Certified Capacity:PRU 50874
with Telepractice Designation
Outpatient Rehabilitation Service (822)
Positive Directions
0Service Type:
Program Name:
Certified Capacity:PRU 51938
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10633_StJose.pdf
January 31, 2022 Page 194 of 227
Certificate Number: 231111733
3rd & 4th Floors, 175-20 Hillside Avenue, Jamaica, New York 11432
Effective: 11/11/2020 11/11/2023
Program Location:
Renewal Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Queens Opioid Treatment Clinic
800Service Type:
Program Name:
Certified Capacity:PRU 52569
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11733_StJose.pdf
Certificate Number: 221111736
211-221 Powell Street, , Brooklyn, New York 11212
Effective: 11/27/2019 11/27/2022
Program Location:
Renewal Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Powell Clinic
450Service Type:
Program Name:
Certified Capacity:PRU 52566
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11736_StJose.pdf
Certificate Number: 210711737
The Maxwell Institute Alcoholism Outpatient Clinic Program, 1st Floor, 92 Yonkers Avenue, Tuckahoe, New York 10707
Effective: 09/25/2019 7/28/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52563
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11737_StJose.pdf
Certificate Number: 230211738
1st and 2nd Floor, 480 Alabama Avenue, Brooklyn, New York 11207
Effective: 02/29/2020 2/28/2023
Program Location:
Renewal Anticipated Recert Review:Deemed
Opioid Treatment Program (822)
Alabama Clinic
700Service Type:
Program Name:
Certified Capacity:PRU 52570
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11738_StJose.pdf
Certificate Number: 210711741
Spellman Building, Ground Floor & 1st Floor, 275 North Street, , Harrison, New York 10528
Effective: 09/25/2019 7/28/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52564
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52565
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11741_StJose.pdf
January 31, 2022 Page 195 of 227
Certificate Number: 210711742
Spellman Building, 1st Floor, 275 North Street, , Harrison, New York 10528
Effective: 09/19/2018 7/28/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818) 30Service Type:
Program Name:
Certified Capacity:PRU 52559
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11742_StJose.pdf
Certificate Number: 210311835
1st Floor, 132 Pearl Street, Port Chester, New York 10573
Effective: 06/07/2019 3/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 52746
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11835_StJose.pdf
Certificate Number: 240112134
18 Spring Street, Port Chester, New York 10573
Effective: 02/01/2021 1/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
Sr. Anne Mary Regan Residence
20Service Type:
Program Name:
Certified Capacity:PRU 53228
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12134_StJose.pdf
St. Lawrence County Community Services Board
Mr. Jay Ulrich, Director of Community Services
Canton Human Services Center, Suite #1, 80 State Highway 310, Canton, NY 13617
Provider Number: 70700
Administrative Office:
Telephone - (315)-379-2276
Certificate Number: 221211007
2nd Floor, 80 State Highway 310, , Canton, New York 13617
Effective: 04/30/2021 12/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
St. Lawrence County Addictions Services Canton
0Service Type:
Program Name:
Certified Capacity:PRU 50188
with Telepractice Designation
99 West Main Street, Gouverneur, NY 13642
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11007_StLawr.pdf
Certificate Number: 230911009
2nd Floor, 206 Ford Street, , Ogdensburg, New York 13699
Effective: 04/30/2021 9/30/2023
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
St. Lawrence County Addiction Services Ogdensburg
0Service Type:
Program Name:
Certified Capacity:PRU 51417
with Telepractice Designation
1st Floor, 21 Harrowgate Commons, Massena, NY 13662
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11009_StLawr.pdf
January 31, 2022 Page 196 of 227
St. Mark's Place Institute For Mental Health, Inc.
Roman Pabis Ph.D., Executive Director
57 St. Mark's Place, New York, NY 10003
Provider Number: 15480
Administrative Office:
Telephone - (212)-982-3470 Ext 124
Certificate Number: 210611011
1st, 2nd and 3rd Floors, 57 St. Mark's Place, New York, New York 10003
Effective: 08/03/2020 6/30/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51582
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11011_StMark.pdf
St. Mary's Healthcare
Mr. Scott Bruce, President & CEO
427 Guy Park Avenue, Amsterdam, NY 12010
Provider Number: 85350
Administrative Office:
Telephone - (518)-841-7101
Certificate Number: 200210615
4th Floor, 4988 State Highway 30, , Amsterdam, New York 12010
Effective: 03/01/2019 2/29/2020
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822) 0Service Type:
Program Name:
Certified Capacity:PRU 50685
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10615_StMary.pdf
Certificate Number: 201110746
2nd and 3rd Floors, 73 North Main Street, Gloversville, New York 12078
Effective: 12/01/2018 11/30/2020
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52614
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10746_StMary.pdf
Certificate Number: 210811404
3rd Floor, 427 Guy Park Avenue, Amsterdam, New York 12010
Effective: 09/01/2018 8/31/2021
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 14Service Type:
Program Name:
Certified Capacity:PRU 51257
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11404_StMary.pdf
Certificate Number: 211011434
4th Floor, 4988 State Highway 30, , Amsterdam, New York 12010
Effective: 09/04/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 100Service Type:
Program Name:
Certified Capacity:PRU 7404
with Telepractice Designation [with ancillary withdrawal services for up to 10 patients]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11434_StMary.pdf
January 31, 2022 Page 197 of 227
St. Peter's Health Partner's, as Sponsor St. Peter's Hospital of the City of Albany, as Operator
Mr. Patrick Carrese, Director
3 Mercycare Lane, Guilderland, NY 12084
Provider Number: 83060
Administrative Office:
Telephone - (518)-452-6707
Certificate Number: 210910254
Gabrilove Pavilion, 6th Floor, 315 South Manning Boulevard, Albany, New York 12208
Effective: 08/04/2020 9/22/2021
Program Location:
Establishment Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6) 18Service Type:
Program Name:
Certified Capacity:PRU 50227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10254_StPete.pdf
Certificate Number: 210710255
64 Second Avenue, Albany, New York 12202
Effective: 09/21/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Community Residential (819)
SPARC Halfway House
22Service Type:
Program Name:
Certified Capacity:PRU 50234
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10255_StPete.pdf
Certificate Number: 210910569
64 Second Avenue, Albany, New York 12202
Effective: 10/06/2020 9/22/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51920
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50233
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10569_StPete.pdf
Certificate Number: 210911017
2nd Floor, 845 Central Avenue, Albany, New York 12206
Effective: 10/06/2020 9/22/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)
SPARC
Service Type:
Program Name:
Certified Capacity:PRU 50232
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11017_StPete.pdf
Certificate Number: 210911018
55 Mohawk Street, Cohoes, New York 12047
Effective: 10/06/2020 9/22/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)
SPARC
Service Type:
Program Name:
Certified Capacity:PRU 50230
with Telepractice Designation [with ancillary withdrawal]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11018_StPete.pdf
January 31, 2022 Page 198 of 227
Certificate Number: 210911429
1st Floor, 2925 Hamburg Street, Rotterdam, New York 12303
Effective: 10/06/2020 9/22/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51810
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11429_StPete.pdf
Certificate Number: 210911430
125 High Rock Avenue, Saratoga Springs, New York 12866
Effective: 10/06/2020 9/22/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50928
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51925
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11430_StPete.pdf
Certificate Number: 210911431
636 New Loudon Road, Latham, New York 12110
Effective: 09/21/2020 9/22/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50927
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11431_StPete.pdf
Certificate Number: 210711463
1st & 2nd Floors, 3 Mercycare Lane, Guilderland, New York 12084
Effective: 09/21/2020 9/22/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
SPARC Inpatient Rehabilitation Program
40Service Type:
Program Name:
Certified Capacity:PRU 51039
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11463_StPete.pdf
Certificate Number: 210712116
Gabrilove Pavilion/Nolan Riddle, 6th Floor, 315 South Manning Boulevard, Albany, New York 12208
Effective: 09/21/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Medically Supervised Outpatient Withdrawal & Stabilization (816.8)
St. Peter's Hospital Detox
45Service Type:
Program Name:
Certified Capacity:PRU 53157
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12116_StPete.pdf
St. Peter's Health Partner's, as Sponsor, Samaritan Hospital of Troy, New York, as Operator
Mr. Michael Finegan, Chief Executive Officer
2215 Burdett Avenue, Troy, NY 12180
Provider Number: 81140
Administrative Office:
Telephone - (518)-525-1990
January 31, 2022 Page 199 of 227
Certificate Number: 210712169
4th Floor, 1300 Massachusetts Avenue, , Troy, New York 12180
Effective: 08/04/2020 7/31/2021
Program Location:
Establishment Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
St. Mary's Hospital Campus
20Service Type:
Program Name:
Certified Capacity:PRU 53306
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12169_Samari.pdf
Certificate Number: 210712170
Floor #4N, 1300 Massachusetts Avenue, , Troy, New York 12180
Effective: 08/04/2020 7/31/2021
Program Location:
Establishment Anticipated Recert Review:
Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 60Service Type:
Program Name:
Certified Capacity:PRU 53305
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12170_Samari.pdf
START Treatment & Recovery Centers, Inc.
Lawrence S. Brown M.D., Chief Executive Officer
937 Fulton Street, Brooklyn, NY 11238
Provider Number: 47570
Administrative Office:
Telephone - (718)-260-2917
Certificate Number: 230410353
1149-55 Myrtle Avenue, Brooklyn, New York 11206
Effective: 05/01/2021 4/30/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822)
ARTC Bushwick MMTP
500Service Type:
Program Name:
Certified Capacity:PRU 80
[with ancillary withdrawal services]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10353_STARTT.pdf
Certificate Number: 240810355
1st & 2nd Floors, 2191 Third Avenue, , New York, New York 10035
Effective: 09/01/2021 8/31/2024
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822)
Third Horizon Clinic
385Service Type:
Program Name:
Certified Capacity:PRU 77
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10355_STARTT.pdf
Certificate Number: 221010356
2nd and 3rd Floors, 2406 Amsterdam Avenue, , New York, New York 10033
Effective: 11/01/2020 10/31/2022
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 350Service Type:
Program Name:
Certified Capacity:PRU 1302
[with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10356_STARTT.pdf
January 31, 2022 Page 200 of 227
Certificate Number: 210710357
1st Floor, 494 Dumont Avenue, Brooklyn, New York 11207
Effective: 03/04/2021 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
East New York Clinic
500Service Type:
Program Name:
Certified Capacity:PRU 78
[with ancillary withdrawal services]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10357_STARTT.pdf
Certificate Number: 210310358
2nd and 3rd Floors, 937 Fulton Street, Brooklyn, New York 11238
Effective: 03/04/2021 3/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Fort Greene Clinic
500Service Type:
Program Name:
Certified Capacity:PRU 7
[with ancillary withdrawal services]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10358_STARTT.pdf
Certificate Number: 210311563
Basement, 4th and 5th Floors, 119-121 West 124th Street, New York, New York 10027
Effective: 03/04/2021 3/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Starting Point Clinic
300Service Type:
Program Name:
Certified Capacity:PRU 6
[with ancillary withdrawal services]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11563_STARTT.pdf
Certificate Number: 230311564
Basement, 2nd and 3rd Floors, 119-121 West 124th Street, New York, New York 10027
Effective: 03/04/2021 3/31/2023
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Kaleidoscope Clinic
300Service Type:
Program Name:
Certified Capacity:PRU 8
[with ancillary withdrawal services]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11564_STARTT.pdf
Certificate Number: 230711572
6th Floor, 119-121 West 124th Street, New York, New York 10027
Effective: 08/01/2021 7/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
REACH Program
Service Type:
Program Name:
Certified Capacity:PRU 52059
[with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11572_STARTT.pdf
State University of New York at Buffalo
Kenneth E. Leonard Ph.D., Director, Research Institute on Addictions
Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203
Provider Number: 30560
Administrative Office:
Telephone - (716)-887-2509
January 31, 2022 Page 201 of 227
Certificate Number: 211211025
Research Institute on Addictions, 1st and 2nd Floors, 1021 Main Street, Buffalo, New York 14203
Effective: 01/01/2020 12/31/2021
Program Location:
Renewal Anticipated Recert Review:
Chemical Dependency Specialized Services (824)
University at Buffalo's Addiction Treatment Services
Service Type:
Program Name:
Certified Capacity:PRU 52735
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11025_StateU.pdf
Steuben County Alcoholism and Substance Abuse Services
Henry Chapman Psy.D., Director
115 Liberty Street, Bath, NY 14810
Provider Number: 70640
Administrative Office:
Telephone - (607)-664-2156
Certificate Number: 220311030
4th Floor, 115 Liberty Street, Bath, New York 14810
Effective: 10/28/2020 3/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50913
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11030_Steube.pdf
Certificate Number: 240311031
114 Chestnut Street, Corning, New York 14830
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50914
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11031_Steube.pdf
Certificate Number: 220611658
1st Floor, 7454 Seneca Road, Hornell, New York 14843
Effective: 10/28/2020 6/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52186
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11658_Steube.pdf
Strong Memorial Hospital
Mr. Steven I. Goldstein, Chief Executive Officer
Room 1-4336, 601 Elmwood Avenue, Rochester, NY 14642
Provider Number: 87080
Administrative Office:
Telephone - (585)-275-7685
January 31, 2022 Page 202 of 227
Certificate Number: 210710465
2613 West Henrietta Road, , Rochester, New York 14623
Effective: 06/10/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Opioid Medical Maintenance (822)Service Type:
Program Name:
Certified Capacity:PRU 7365
Opioid Treatment Program (822) 500Service Type:
Program Name:
Certified Capacity:PRU 665
with Telepractice Designation [with ancillary withdrawal services for up to 50 patients]
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10465_Strong.pdf
Certificate Number: 220411095
Suite C & D, 2613 West Henrietta Road, , Rochester, New York 14623
Effective: 06/10/2020 4/6/2022
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Outpatient Service (822)
AYA (Adolescents/Young Adults)
0Service Type:
Program Name:
Certified Capacity:PRU 53464
withTelepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11095_Strong.pdf
Student Assistance Services Corporation
Ms. Ellen R. Morehouse, Executive Director
1st Floor, 660 White Plains Road, Tarrytown, NY 10591
Provider Number: 34310
Administrative Office:
Telephone - (914)-332-1300
Certificate Number: 220111978
1st Floor, 660 White Plains Road, Tarrytown, New York 10591
Effective: 09/01/2021 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Prevention Counseling
Student Assistance Services
Service Type:
Program Name:
Certified Capacity:PRU 90672
with Telepractice Designation
Saunders Trade and Technical High School, 183 Palmer Road, Yonkers, NY 10701
Other Service Site(s) At:
Fox Lane High School, South Bedford Road, Bedford, NY 10506
Other Service Site(s) At:
Pelham Middle School, 28 Franklin Place, Pelham, NY 10803
Other Service Site(s) At:
Irvington High School, 40 North Broadway, Irvington, NY 10536
Other Service Site(s) At:
Lincoln High School, 375 Kneeland Avenue, Yonkers, NY 10704
Other Service Site(s) At:
Blindbrook High School, 840 King Street, Rye Brook, NY 10573
Other Service Site(s) At:
Lakeland Copper Beach Middle School, 3401 Old Yorktown Road, Yorktown Heights, NY 10598
Other Service Site(s) At:
January 31, 2022 Page 203 of 227
Alexander Hamilton Junior/Senior High School, South Goodwin Avenue, Elmsford, NY 10523
Other Service Site(s) At:
Sleepy Hollow High School, 210 North Broadway, North Tarrytown, NY 10591
Other Service Site(s) At:
Horace Greeley High School D Building, 70 Roaring Brook Road, Chappaqua, NY 10514
Other Service Site(s) At:
Briarcliff Middle School, 444 Pleasantville Road, Briarcliff Manor, NY 10510
Other Service Site(s) At:
Yonkers Montessori Academy, 160 Woodlawn Avenue, Yonkers, NY 10704
Other Service Site(s) At:
Pierre Van Cortlandt Middle School, 3 Glen Place, Croton-on-Hudson, NY 10520
Other Service Site(s) At:
Peekskill Middle School, 212 Ringgold Street, Peekskill, NY 10566
Other Service Site(s) At:
Riverside High School, 565 Warburton Avenue, Yonkers, NY 10701
Other Service Site(s) At:
White Plains High School, 550 North Street, White Plains, NY 10605
Other Service Site(s) At:
Blue Mountain Middle School, 7 Furnace Woods Road, Cortlandt Manor, NY 10567
Other Service Site(s) At:
Dobbs Ferry Senior High School, 505 Broadway, Dobbs Ferry, NY 10522
Other Service Site(s) At:
Palisades Preparatory School, 201 Palisade Avenue, Yonkers, NY 10703
Other Service Site(s) At:
Croton-Harmon High School, 36 Old Post Road South, Croton-on-Hudson, NY 10520
Other Service Site(s) At:
Byram Hills High School, 12 Tripp Lane, Armonk, NY 10504
Other Service Site(s) At:
New Rochelle High School, 265 Clove Road, New Rochelle, NY 10801
Other Service Site(s) At:
Roosevelt High School, 631 Tuckahoe Road, Yonkers, NY 10710
Other Service Site(s) At:
Yorktown High School, 2727 Crompond Road, Yorktown Heights, NY 10598
Other Service Site(s) At:
Walter Panas High School, 300 Croton Avenue, Cortland Manor, NY 10566
Other Service Site(s) At:
Pelham High School, 575 Colonial Avenue, Pelham, NY 10803
Other Service Site(s) At:
Hendrick Hudson High School, Albany Post Road, Montrose, NY 10548
Other Service Site(s) At:
White Plains Middle School/Highlands, 128 Grandview Avenue, White Plains, NY 10605
Other Service Site(s) At:
Somers High School, Route 139, Lincolndale, NY 10540
Other Service Site(s) At:
Yonkers High School, 150 Rockland Avenue, Yonkers, NY 10705
Other Service Site(s) At:
Ardsley Middle School, 700 Ashford Avenue, Ardsley, NY 10502
Other Service Site(s) At:
January 31, 2022 Page 204 of 227
Lakeland High School, 1349 East Main Street, Shrub Oak, NY 10588
Other Service Site(s) At:
Harrison High School, 255 Union Street, Harrison, NY 10528
Other Service Site(s) At:
Peekskill High School, 1072 Elm Street, Peekskill, NY 10566
Other Service Site(s) At:
Briarcliff High School, 445 Pleasantville Road, Briarclliff, NY 10510
Other Service Site(s) At:
Gorton High School, 100 Shonnard Place, Yonkers, NY 10703
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11978_Studen.pdf
Substance Abuse Prevention Team of Essex County, Inc.
Mr. Douglas Terbeek, Executive Director
173 Lord Howe Street, Ticonderoga, NY 12883
Provider Number: 2185
Administrative Office:
Telephone - (518)-585-7424 Ext 101
Certificate Number: 240312007
173 Lord Howe Street, Ticonderoga, New York 12883
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90642
Lake Placid Junior/Senior High School, 4th Floor, Room 305, 34 School Street, Lake Placid, NY 12946
Other Service Site(s) At:
Moriah Central School, Elementary Wing, 2nd Floor, Room 218, 39 Viking Lane, Port Henry, NY 12974
Other Service Site(s) At:
Willsboro Central School, 1st Floor, Room E127, 29 School Lane, Willsboro, NY 12996
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12007_Substa.pdf
Success Counseling Services, Inc.
Mr Josh Greenfeld, CEO
1015 Ogden Avenue, Bronx, NY 10452
Provider Number: 29070
Administrative Office:
Telephone - (718)-538-6112
Certificate Number: 220411032
1015-1017 Ogden Avenue, , Bronx, New York 10452
Effective: 08/16/2021 4/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51788
with Telepractice Designation
Success Counseling Services, Inc., 1038 Ogden Avenue, Bronx, NY 10452
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11032_Succes.pdf
Suffolk County Department of Health Services
Ms. Cari F. Besserman, Director
William J. Lindsay Complex - Bldg C016, 725 Veterans Memorial Highway, P.O. Box 6100, Hauppauge, NY 11788
Provider Number: 70370
Administrative Office:
Telephone - (631)-853-3108
January 31, 2022 Page 205 of 227
Certificate Number: 230310392
200 Wireless Boulevard, Hauppauge, New York 11788
Effective: 09/09/2020 3/31/2023
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 300Service Type:
Program Name:
Certified Capacity:PRU 3097
with Telepratice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10392_Suffol.pdf
Certificate Number: 211010393
2nd Floor, 300 Center Drive, Riverhead, New York 11901
Effective: 09/09/2020 10/31/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822)
Division of Community Mental Hygiene Services
275Service Type:
Program Name:
Certified Capacity:PRU 6731
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10393_Suffol.pdf
Certificate Number: 210210394
689 East Jericho Turnpike, Huntington Station, New York 11746
Effective: 09/09/2020 2/28/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 300Service Type:
Program Name:
Certified Capacity:PRU 202
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10394_Suffol.pdf
Certificate Number: 210910395
William J. Lindsay Complex, Building 151, 725 Veterans Memorial Highway, , Smithtown, New York 11787
Effective: 09/09/2020 9/30/2021
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 300Service Type:
Program Name:
Certified Capacity:PRU 201
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10395_Suffol.pdf
Sullivan County Department of Community Services
Ms. Melissa Stickle LCSW-R, CASAC, Director
20 Community Lane, PO Box 716, Liberty, NY 12754
Provider Number: 70170
Administrative Office:
Telephone - (845)-292-8770 Ext 2097
Certificate Number: 210610595
2nd Floor, 20 Community Lane, Liberty, New York 12754
Effective: 03/19/2019 6/30/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)
Sullivan County Alcohol and Drug Abuse Services
0Service Type:
Program Name:
Certified Capacity:PRU 50430
with telepractice designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10595_Sulliv.pdf
Syracuse Community Health Center, Inc.
Mr. Mark Hall, President & CEO
819 South Salina Street, Syracuse, NY 13202
Provider Number: 36260
Administrative Office:
Telephone - (315)-476-0642
January 31, 2022 Page 206 of 227
Certificate Number: 210511039
1st Floor, 819 South Salina Street, Syracuse, New York 13202
Effective: 06/01/2019 5/31/2021
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50934
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11039_Syracu.pdf
Syracuse Recovery Services, LLC
Ms. Lisa J. Forshee, Director
319 East Water Street, Syracuse, NY 13202
Provider Number: 47230
Administrative Office:
Telephone - (315)-282-5351
Certificate Number: 220911710
319 East Water Street, Syracuse, New York 13202
Effective: 07/01/2020 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52520
with Telepractice Designation
180 Genesee Street, Auburn, NY 13021
Additional Location(s) At:
Euclid Med Bldg, 1st Floor, Suite 5, 6 Euclid Avenue, Cortland, NY 13045
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11710_Syracu.pdf
T.R.I. Center, Inc.
Mr. Jose Gonzalez, President and CEO
1369 Broadway, New York, NY 10018
Provider Number: 16350
Administrative Office:
Telephone - (212)-268-8830
Certificate Number: 210711041
2nd and 3rd Floors, 1369 Broadway, New York, New York 10018
Effective: 07/01/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6015
with Telepractice Designation
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51959
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11041_TRICen.pdf
Certificate Number: 220111465
11th Floor, 175 Remsen Street, , Brooklyn, New York 11201
Effective: 04/12/2021 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6402
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11465_TRICen.pdf
January 31, 2022 Page 207 of 227
Certificate Number: 231211466
Suite 415-423, 2488 Grand Concourse, Bronx, New York 10458
Effective: 01/01/2021 12/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6134
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11466_TRICen.pdf
Tempo Group, Inc.
Ms. Cindy Wolff, Executive Director
112 Franklin Place, Woodmere, NY 11598
Provider Number: 313
Administrative Office:
Telephone - (516)-374-3671
Certificate Number: 200911043
112 Franklin Place, , Woodmere, New York 11598
Effective: 05/15/2020 9/30/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Woodmere Clinic
Service Type:
Program Name:
Certified Capacity:PRU 7066
with Telepractice Designation
23 Willis Avenue, Syosset, NY 11791
Additional Location(s) At:
1st Floor, 1260 Meadowbrook Road, North Merrick, NY 11566
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11043_TempoG.pdf
Certificate Number: 220712294
112 Franklin Place, , Woodmere, New York 11598
Effective: 08/01/2019 7/31/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention Counseling
Woodmere Clinic
Service Type:
Program Name:
Certified Capacity:PRU 90583
Merrick Middle School, 1st Floor, Social Worker's Office, 1870 Merrick Avenue, Merrick, NY 11566
Other Service Site(s) At:
John F. Kennedy High School, 1st Floor, Room 131, 3000 Bellmore Avenue, Bellmore, NY 11710
Other Service Site(s) At:
1st Floor, 1260 Meadowbrook Road, North Merrick, NY 11566
Other Service Site(s) At:
Grand Avenue Middle School, 1st Floor, Room 127, 2301 Grand Avenue, Bellmore, NY 11710
Other Service Site(s) At:
Wellington C. Mepham High School, 1st Floor, Social Worker's Office, 2401 Camp Avenue, Bellmore, NY 11710
Other Service Site(s) At:
Sanford H. Calhoun High School, 1st Floor, Room 113, 1786 State Street, Merrick, NY 11566
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/
Tioga County Community Services Board
Ms Lori Morgan, Director of Community Services
1062 State Route 38, P.O. Box 177, Owego, NY 13827
Provider Number: 70510
Administrative Office:
Telephone - (607)-689-8139
January 31, 2022 Page 208 of 227
Certificate Number: 211111080
1st Floor, 1062 NYS Route 38, , Owego, New York 13827
Effective: 06/22/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Tioga County Alcohol & Drug Services
Service Type:
Program Name:
Certified Capacity:PRU 554
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11080_TiogaC.pdf
Town of Babylon
Mr. Joseph Olmedo, Director
Babylon Town Hall, 1st Floor, 200 East Sunrise Highway, Lindenhurst, NY 11757
Provider Number: 372
Administrative Office:
Telephone - (631)-422-7676
Certificate Number: 231211544
281 Phelps Lane , North Babylon, New York 11703
Effective: 01/01/2021 12/31/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 560
with Telepractice Designation [with ancillary withdrawal services]
Lindenhurst High School, Adult Education Suite, 300 Charles Street, Lindenhurst, NY 11757
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11544_Townof.pdf
Town of Smithtown
Mr Matthew Neebe, Executive Director
161 East Main Street, Smithtown, NY 11787
Provider Number: 667
Administrative Office:
Telephone - (631)-360-7578
Certificate Number: 220711084
161 East Main Street, Smithtown, New York 11787
Effective: 07/10/2020 7/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Horizons Counseling & Education Center
Service Type:
Program Name:
Certified Capacity:PRU 7116
with Telepractice Designation
Hauppauge High School, Room #144, 500 Lincoln Boulevard, Hauppauge, NY 11788
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11084_Townof.pdf
Trinity Alliance of the Capital Region, Inc.
Mr. Harris Oberlander, Chief Executive Officer
15 Trinity Place, Albany, NY 12202
Provider Number: 24440
Administrative Office:
Telephone - (518)-449-5155 Ext 116
Certificate Number: 240212146
76-82 2nd Street, Albany, New York 12210
Effective: 03/01/2021 2/29/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 20Service Type:
Program Name:
Certified Capacity:PRU 53244
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12146_Trinit.pdf
January 31, 2022 Page 209 of 227
Triumph Treatment LLC
Mr. Edward Rebenwurzel, Managing Partner
2808 Avenue P, Brooklyn, NY 11229
Provider Number: 50670
Administrative Office:
Telephone - (347)-524-1832
Certificate Number: 200112168
2nd Floor, 309 West Park Avenue, , Long Beach, New York 11561
Effective: 02/01/2019 1/31/2020
Program Location:
Establishment Anticipated Recert Review:
Opioid Treatment Program (822) 25Service Type:
Program Name:
Certified Capacity:PRU 53303
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12168_Triump.pdf
The Tully Hill Corporation
s.. Cathy L. Palm, Executive Director
5821 State Route 80, P.O. Box 1116, Tully, NY 13159
Provider Number: 32611
Administrative Office:
Telephone - (315)-696-6114
Certificate Number: 221110102
5821 State Route 80, , Tully, New York 13159
Effective: 12/01/2019 11/30/2022
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7)
The Tully Hill Corporation
8Service Type:
Program Name:
Certified Capacity:PRU 8050
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10102_TullyH.pdf
Certificate Number: 201211073
5821 State Route 80, , Tully, New York 13159
Effective: 03/03/2020 12/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
The Tully Hill Corporation
Service Type:
Program Name:
Certified Capacity:PRU 51660
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11073_TullyH.pdf
Certificate Number: 230111418
5821 State Route 80, , Tully, New York 13159
Effective: 02/01/2020 1/31/2023
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
The Tully Hill Corporation
42Service Type:
Program Name:
Certified Capacity:PRU 51062
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11418_TullyH.pdf
Twin County Recovery Services, Inc.
Ms. Karen Karl, Chief Administrator
350 Powers Avenue, Hudson, NY 12534
Provider Number: 35010
Administrative Office:
Telephone - 518-751-2083 Ext 1140
Certificate Number: 181210122
437-441 Columbia Street, Hudson, New York 12534
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
The Red Door Community Residence
13Service Type:
Program Name:
Certified Capacity:PRU 51164
with Telepractice Designation
January 31, 2022 Page 210 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10122_TwinCo.pdf
Certificate Number: 181210339
Grade Level, 428 West Main Street, Catskill, New York 12414
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Riverside Recovery Residence
12Service Type:
Program Name:
Certified Capacity:PRU 51765
[maximum certified occupancy can be no more than 16 persons] with Telepractice Designation
and up to 6 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10339_TwinCo.pdf
Certificate Number: 230611087
1st Floor, 428 West Main Street, Catskill, New York 12414
Effective: 07/01/2021 6/30/2023
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6865
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11087_TwinCo.pdf
Certificate Number: 220111088
350 Power Avenue, Hudson, New York 12534
Effective: 09/09/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50146
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11088_TwinCo.pdf
Certificate Number: 240511981
Administrative Site Only:, 388 Main Street, , Catskill, New York 12414
Effective: 06/01/2021 5/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90675
with Telepractice Designation
Coxsackie-Athens School, 1st Floor, Counselor's Suite, 24 Sunset Boulevard, Coxsackie, NY 12051
Other Service Site(s) At:
Cairo-Durham CSD, High School Main Office, 1301 Route 145, Cairo, NY 12413
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11981_TwinCo.pdf
Unitas Therapeutic Community, Inc.
Ian S. Amritt Ph.D., Executive Director
4th Floor, 830 Southern Boulevard, Bronx, NY 10459
Provider Number: 1537
Administrative Office:
Telephone - (718)-589-0551 Ext 1005
Certificate Number: 220811980
St. Athanasius School, 830 Southern Boulevard, Bronx, New York 10459
Effective: 09/01/2019 8/31/2022
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90746
January 31, 2022 Page 211 of 227
The Hyde Charter School, 4th Floor, 730 Bryant Avenue, Bronx, NY 10474
Other Service Site(s) At:
The Bronx Studio School for Writers and Artists, 928 Simpson Street, Bronx, NY 10459
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11980_Unitas.pdf
United Activities Unlimited, Inc.
Steven Matteo, Chief Executive Officer
Building P, 3rd Floor, 1000 Richmond Terrace, Staten Island, NY 10301
Provider Number: 1786
Administrative Office:
Telephone - 917-975-5541
Certificate Number: 240312033
Administrative Site Only:, Building P, Floor #3, 1000 Richmond Terrace, Staten Island, New York 10301
Effective: 04/01/2021 3/31/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention CounselingService Type:
Program Name:
Certified Capacity:PRU 90749
P.S. 4, 1st Floor, Room 123, 200 Nedra Lane, Staten Island, NY 10312
Other Service Site(s) At:
I.S. 72, 1st Floor, Room 128, 33 Ferndale Avenue, Staten Island, NY 10314
Other Service Site(s) At:
P.S. 56, 1st Floor, Counseling Room, 250 Kramer Avenue, Staten Island, NY 10309
Other Service Site(s) At:
I.S. 51, 2nd Floor, Room 254, 20 Houston Street, Staten Island, NY 10302
Other Service Site(s) At:
New Dorp HS, 465 New Dorp Lane, Staten Island, NY 10306
Other Service Site(s) At:
PS 55, 54 Osborne Avenue, Staten Island, NY 10302
Other Service Site(s) At:
P.S. 18, 1st Floor, Room 14, 221 Broadway, Staten Island, NY 10310
Other Service Site(s) At:
P.S. 52, 1st Floor, Room 121, 480 Buel Avenue, Staten Island, NY 10305
Other Service Site(s) At:
P.S. 44, 1st Floor, Room 2066, 80 Maple Parkway, Staten Island, NY 10303
Other Service Site(s) At:
I.S. 75, 1st Floor, Room 111, 455 Huguenot Avenue, Staten Island, NY 10312
Other Service Site(s) At:
I.S. 24, 1st Floor, Counseling Room, 225 Cleveland Avenue, Staten Island, NY 10308
Other Service Site(s) At:
PS 20, 161 Park Avenue, Staten Island, NY 10302
Other Service Site(s) At:
I.S. 34, 3rd Floor, Room 4037, 528 Academy Avenue, Staten Island, NY 10307
Other Service Site(s) At:
Todt Hill Houses - Building #4, 1st Floor, Community Room, 263 Westwood Avenue, Staten Island, NY 10314
Other Service Site(s) At:
I.S. 7, 1st Floor, Room 136, 1270 Huguenot Avenue, Staten Island, NY 10312
Other Service Site(s) At:
I.S. 2, 1st Floor, Counseling Room, 333 Midland Avenue, Staten Island, NY 10306
Other Service Site(s) At:
January 31, 2022 Page 212 of 227
P.S. 19, 1st Floor, Room 105, 780 Post Avenue, Staten Island, NY 10310
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12033_United.pdf
United Health Services Hospitals, Inc.
Mr. John J. Carrigg, President and Chief Executive Officer
10-42 Mitchell Avenue, Binghamton, NY 13903
Provider Number: 85330
Administrative Office:
Telephone - (607)-762-2260
Certificate Number: 231110451
Binghamton General Hospital, Ground Level, 10-42 Mitchell Avenue, Binghamton, New York 13903
Effective: 12/01/2020 11/30/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 150Service Type:
Program Name:
Certified Capacity:PRU 691
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10451_United.pdf
Certificate Number: 220111094
Binghamton General Hospital, 2nd Floor, 10-42 Mitchell Avenue, Binghamton, New York 13903
Effective: 05/28/2020 1/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
New Horizons Chemical Dependency Treatment Center
Service Type:
Program Name:
Certified Capacity:PRU 50599
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11094_United.pdf
Certificate Number: 211211421
Binghamton General Hospital, Memorial 4, 10-42 Mitchell Avenue, Binghamton, New York 13903
Effective: 05/28/2020 12/8/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
New Horizons Chemical Dependency Treatment Center
20Service Type:
Program Name:
Certified Capacity:PRU 50598
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11421_United.pdf
United Memorial Medical Center
Ms. Mandy Teeter, Vice President, Rochester Regional Health-Behavioral Health
127 North Street, Batavia, NY 14020
Provider Number: 82230
Administrative Office:
Telephone -
Certificate Number: 231011857
2nd Floor, 16 Bank Street, Batavia, New York 14020
Effective: 10/03/2020 10/3/2023
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
Hope Haven
22Service Type:
Program Name:
Certified Capacity:PRU 50957
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11857_United.pdf
January 31, 2022 Page 213 of 227
The Unity Hospital of Rochester
Ms. Mandy Teeter, Vice President, Rochester Regional Health-Behavioral Health
Evelyn Brandon Health Center, 3rd Floor, 81 Lake Avenue, Rochester, NY 14608
Provider Number: 83250
Administrative Office:
Telephone - (585)-368-6989
Certificate Number: 210510517
Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626
Effective: 09/10/2020 5/12/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Medically Supervised Outpatient Withdrawal & Stabilization (816.8) 9Service Type:
Program Name:
Certified Capacity:PRU 8043
[without the use of methadone] with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10517_UnityH.pdf
Certificate Number: 220210921
Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626
Effective: 09/10/2020 2/28/2022
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50762
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10921_UnityH.pdf
Certificate Number: 220110922
Building 2, 1st Floor, 2000 Winton Road South, , Rochester, New York 14618
Effective: 08/04/2021 1/31/2022
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 50764
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10922_UnityH.pdf
Certificate Number: 230210923
2nd Floor, 81 Lake Avenue, Rochester, New York 14608
Effective: 03/01/2020 2/28/2023
Program Location:
Renewal Anticipated Recert Review:Deemed
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51607
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10923_UnityH.pdf
Certificate Number: 210511391
Chemical Dependency Building, 1565 Long Pond Road, Rochester, New York 14626
Effective: 09/10/2020 5/12/2021
Program Location:
Amendment Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818) 40Service Type:
Program Name:
Certified Capacity:PRU 50904
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11391_UnityH.pdf
Unity House of Cayuga County, Inc.
Ms. Elizabeth Smith, Executive Director
Administrative Offices only, Suite 14, 217 Genesee Street, Auburn, NY 13021
Provider Number: 23570
Administrative Office:
Telephone - (315)-253-6227 Ext 320
January 31, 2022 Page 214 of 227
Certificate Number: 181210067
58 Osborne Street, Auburn, New York 13021
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819)
Unity House
19Service Type:
Program Name:
Certified Capacity:PRU 51701
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10067_UnityH.pdf
Certificate Number: 181210068
58 Osborne Street, Auburn, New York 13021
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Grace House
16Service Type:
Program Name:
Certified Capacity:PRU 51176
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10068_UnityH.pdf
University Hospital - Stony Brook Eastern Long Island Hospital
Ms. Carol Gomes, Interim Chief Executive Officer
Room 221, Level 4, 101 Nicolls Road, Stony Brook, NY 11794
Provider Number: 81310
Administrative Office:
Telephone - (631)-444-2701
Certificate Number: 200610227
2nd Floor, 201 Manor Place, , Greenport, New York 11944
Effective: 08/06/2019 6/30/2020
Program Location:
Amendment Anticipated Recert Review:Deemed
Medically Managed Withdrawal & Stabilization Services (816.6)
Quannacut Detoxification Unit at Stony Brook Eastern Long Island Hospital
10Service Type:
Program Name:
Certified Capacity:PRU 51661
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10227_StonyB.pdf
Certificate Number: 200611053
905 East Main Street, , Riverhead, New York 11901
Effective: 05/29/2020 6/30/2020
Program Location:
Amendment Anticipated Recert Review:Deemed
Outpatient Service (822)
Stony Brook Medicine - Quannacut Outpatient Services
Service Type:
Program Name:
Certified Capacity:PRU 51122
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11053_Univer.pdf
Certificate Number: 200611411
2nd Floor, 201 Manor Place, , Greenport, New York 11944
Effective: 08/06/2019 6/30/2020
Program Location:
Amendment Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818)
Quannacut Inpatient Services at Stony Brook Eastern Long Island Hospital
20Service Type:
Program Name:
Certified Capacity:PRU 50845
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11411_Univer.pdf
UPMC Chautauqua Services, Inc. as Sponsor UPMC Chautauqua at WCA as Operator
Mr. Brian Durniok, President and Chief Executive Officer
207 Foote Avenue, P.O. Box 840, Jamestown, NY 14701
Provider Number: 81610
Administrative Office:
Telephone - (716)-664-8421
January 31, 2022 Page 215 of 227
Certificate Number: 240412054
2M Main Floor, 51 Glasgow Avenue, Jamestown, New York 14701
Effective: 05/01/2021 4/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
UPMC Chautauqua WCA OP
Service Type:
Program Name:
Certified Capacity:PRU 53048
with Telepractice Designation [with ancillary withdrawal services]
306 Central Avenue, Dunkirk, NY 14048
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12054_UPMCCh.pdf
Certificate Number: 210112055
4th Floor, 207 Foote Avenue, Jamestown, New York 14701
Effective: 04/26/2018 1/27/2021
Program Location:
Renewal Anticipated Recert Review:Deemed
Inpatient Rehabilitation Service ( 818) 15Service Type:
Program Name:
Certified Capacity:PRU 53049
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12055_UPMCCH.pdf
Certificate Number: 230412204
4th Floor Main, 51 Glasgow Avenue, , Jamestown, New York 14701
Effective: 05/01/2021 4/30/2023
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820)
UPMC Behavioral Health Wellness Center
20Service Type:
Program Name:
Certified Capacity:PRU 53338
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12204_UPMCCh.pdf
Upper Manhattan Mental Health Center, Inc.
Mr. Thomas Haggerty Jr., Executive Director
1727 Amsterdam Avenue, New York, NY 10031
Provider Number: 70490
Administrative Office:
Telephone - (212)-694-9200
Certificate Number: 181210213
2009 3rd Avenue, New York, New York 10029
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819) 20Service Type:
Program Name:
Certified Capacity:PRU 51809
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10213_UpperM.pdf
Certificate Number: 210711097
3rd Floor, 1727 Amsterdam Avenue, New York, New York 10031
Effective: 06/22/2020 7/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Alcoholism & Substance Abuse Treatment Program
Service Type:
Program Name:
Certified Capacity:PRU 50962
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11097_UpperM.pdf
January 31, 2022 Page 216 of 227
Urban Recovery House LLC
Mr. Zev Friedman, Acting CEO
411 Van Brunt Street, Brooklyn, NY 11231
Provider Number: 50560
Administrative Office:
Telephone - (646)-960-6656
Certificate Number: 220112163
1st - 5th Floors, 411 Van Brunt Street, , Brooklyn, New York 11231
Effective: 02/01/2020 1/31/2022
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 30Service Type:
Program Name:
Certified Capacity:PRU 53294
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12163_UrbanR.pdf
Certificate Number: 211212175
1st Floor, 411 Van Brunt Street, , Brooklyn, New York 11231
Effective: 01/01/2020 12/31/2021
Program Location:
Renewal Anticipated Recert Review:
Medically Supervised Inpatient Withdrawal & Stabilization Services (816.7) 6Service Type:
Program Name:
Certified Capacity:PRU 53295
with Telepractice Designation [with the use of methadone]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12175_UrbanR.pdf
VERTEX LLC
Mr. Paul Henderson, Executive Director
1080 East Gun Hill Road, Bronx, NY 10469
Provider Number: 44120
Administrative Office:
Telephone - (718)-653-1117
Certificate Number: 200811484
1st & 2nd Floors, 1080 East Gun Hill Road, Bronx, New York 10469
Effective: 01/01/2018 8/31/2020
Program Location:
Special ReIssue Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51992
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11484_VERTEX.pdf
Veterans Outreach Center, Inc.
Ms. Laura Stradley, Executive Director
459 South Avenue, Rochester, NY 14620
Provider Number: 43890
Administrative Office:
Telephone - (585)-295-7800
Certificate Number: 190711471
Administrative Site:, 290 Cypress Street, , Rochester, New York 14620
Effective: 11/09/2018 7/31/2019
Program Location:
Amendment Anticipated Recert Review:
Supportive Living (819) 6Service Type:
Program Name:
Certified Capacity:PRU 51991
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11471_Vetera.pdf
Vida Family Services, Inc.
Mr. Christopher Nazario, Executive Director
127 East 105th Street, New York, NY 10029
Provider Number: 1249
Administrative Office:
Telephone - (929)-300-4867 Ext 18
January 31, 2022 Page 217 of 227
Certificate Number: 221211100
127 East 105th Street, New York, New York 10029
Effective: 01/01/2021 12/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7179
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11100_VidaFa.pdf
Villa of Hope
Ms. Christina M. Gullo, Chief Executive Officer/President
3300 Dewey Avenue, Rochester, NY 14616
Provider Number: 37220
Administrative Office:
Telephone - (585)-865-1550 Ext 100
Certificate Number: 210411362
Building J, Room 202, 2nd Floor, 1099 Jay Street, Rochester, New York 14611
Effective: 09/01/2020 4/30/2021
Program Location:
Amendment Anticipated Recert Review:OMH Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51886
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11362_Villao.pdf
Certificate Number: 211211629
Life Residence, 3300 Dewey Avenue, , Rochester, New York 14616
Effective: 09/01/2020 12/31/2021
Program Location:
Amendment Anticipated Recert Review:
Residential Rehabilitation Services for Youth (817)
Life Program
14Service Type:
Program Name:
Certified Capacity:PRU 4856
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11629_Villao.pdf
Certificate Number: 220412265
3300 Dewey Avenue, , Rochester, New York 14616
Effective: 05/17/2021 4/30/2022
Program Location:
Establishment Anticipated Recert Review:
Community Psychiatric Support & Treatment (CPST)Service Type:
Program Name:
Certified Capacity:PRU 53552
Other Licensed PractitionersService Type:
Program Name:
Certified Capacity:PRU 53556
Psychosocial Rehabilitation (PSR)Service Type:
Program Name:
Certified Capacity:PRU 53553
Family Peer Support and ServicesService Type:
Program Name:
Certified Capacity:PRU 53554
Youth Peer Support and TrainingService Type:
Program Name:
Certified Capacity:PRU 53555
January 31, 2022 Page 218 of 227
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12265_Villao.pdf
Villa Veritas Foundation, Inc.
Ms. Suzanne Cusack, Executive Director
5 Ridgeview Road, Kerhonkson, NY 12446
Provider Number: 47750
Administrative Office:
Telephone - (845)-626-3555
Certificate Number: 220111752
5 Ridgeview Road, , Kerhonkson, New York 12446
Effective: 02/01/2020 1/31/2022
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 35Service Type:
Program Name:
Certified Capacity:PRU 52585
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11752_VillaV.pdf
Certificate Number: 190311864
5 Ridgeview Road, , Kerhonkson, New York 12446
Effective: 01/01/2018 3/31/2019
Program Location:
Special ReIssue Anticipated Recert Review:
Intensive Residential Rehabilitation (819) 50Service Type:
Program Name:
Certified Capacity:PRU 52803
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11864_VillaV.pdf
Village of Haverstraw Drug Abuse Prevention Council
Ms. Marion E. Breland, Executive Director
Haverstraw Center, 50 West Broad Street, Haverstraw, NY 10927
Provider Number: 1779
Administrative Office:
Telephone - (845)-429-5731 Ext 11
Certificate Number: 240911965
Village of Haverstraw Youth and Family/Community Center, 50 West Broad Street, Haverstraw, New York 10927
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention Counseling
Village of Haverstraw Drug Abuse Prevention Counseling
Service Type:
Program Name:
Certified Capacity:PRU 90633
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11965_Villag.pdf
Vocational Instruction Project Community Services, Inc.
Ms. Debbian Fletcher-Blake, Chief Executive Officer
6th Floor, 770 East 176th Street, Bronx, NY 10460
Provider Number: 325
Administrative Office:
Telephone - (718)-583-5150 Ext 8650
January 31, 2022 Page 219 of 227
Certificate Number: 201110366
1st & 3rd Floors, 770 East 176th Street, , Bronx, New York 10460
Effective: 10/15/2019 11/30/2020
Program Location:
Amendment Anticipated Recert Review:OASAS Host
Integrated Outpatient Services - PCService Type:
Program Name:
Certified Capacity:PRU
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Opioid Full Agonist Treatment Program (822) 1000Service Type:
Program Name:
Certified Capacity:PRU 670
with Telepractice Designation [with ancillary withdrawal services for up to 100 patients]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10366_Vocati.pdf
Certificate Number: 200511287
4th Floor, 770 East 176th Street, , Bronx, New York 10460
Effective: 10/15/2019 5/31/2020
Program Location:
Conditional Certificate Anticipated Recert Review:OASAS Host
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 6868
with Telepractice Designation [with ancillary withdrawal services]
Integrated Outpatient Services - PCService Type:
Program Name:
Certified Capacity:PRU
Integrated Outpatient Services - MHService Type:
Program Name:
Certified Capacity:PRU
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11287_Vocati.pdf
Certificate Number: 241012045
716 Fairmount Place, Bronx, New York 10457
Effective: 11/01/2021 10/31/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 40Service Type:
Program Name:
Certified Capacity:PRU 53043
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12045_Vocati.pdf
Certificate Number: 241112046
764 East 176th Street, Bronx, New York 10460
Effective: 12/01/2021 11/30/2024
Program Location:
Renewal Anticipated Recert Review:
Residential Services (820) 80Service Type:
Program Name:
Certified Capacity:PRU 53042
with Telepractice Designation
Elements: Stabilization Rehabilitation Reintegration Congregate Scattered
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12046_Vocati.pdf
January 31, 2022 Page 220 of 227
Volunteers of America - Greater New York, Inc.
Ms. Terre Pettitt, President and Chief Executive Officer
340 West 85th Street, New York, NY 10024
Provider Number: 22790
Administrative Office:
Telephone - (212)-496-4300
Certificate Number: 181210066
395 Webster Avenue, New Rochelle, New York 10801
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Community Residential (819)
Crossroads
17Service Type:
Program Name:
Certified Capacity:PRU 51043
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10066_Volunt.pdf
Wayne County Community Services Board
Mr. James M. Haitz LCSW-R, Director of Community Services
1519 Nye Road, Lyons, NY 14489
Provider Number: 70540
Administrative Office:
Telephone - (315)-946-5722
Certificate Number: 221011102
Rooms 113-120, 122-123A, 148, 149, 149A-149F, 198 & 199, 1st Floor, 1519 Nye Road, , Lyons, New York 14489
Effective: 05/15/2020 10/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Wayne Substance Abuse Services
Service Type:
Program Name:
Certified Capacity:PRU 4168
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11102_WayneC.pdf
WellLife Network Inc.
Ms. Sherry Tucker, Chief Executive Officer
142-02 20th Avenue, Flushing, NY 11351
Provider Number: 21920
Administrative Office:
Telephone - (718)-559-0518
Certificate Number: 240612021
234 Long Island Avenue, Wyandanch, New York 11798
Effective: 07/01/2021 6/30/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52975
with Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12021_PSCHin.pdf
Certificate Number: 240712022
2nd Floor, 11 Route 111, , Smithtown, New York 11787
Effective: 08/01/2021 7/31/2024
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)
Addiction Recovery Services (ARS)
0Service Type:
Program Name:
Certified Capacity:PRU 52976
[with ancillary withdrawal] and Telepractice and Problem Gambling Designations
2nd Floor, 3600 Route 112, Coram, NY 11727
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12022_PSCHIn.pdf
January 31, 2022 Page 221 of 227
Certificate Number: 200912023
Room #s 6, 63 and 64, 1st Floor, 55 Horizon Drive, Huntington, New York 11743
Effective: 07/01/2020 9/30/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 52977
[with ancillary withdrawal] and Telepractice and Problem Gambling Designations
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12023_PSCHIn.pdf
West Midtown Management Group, Inc.
Ms. Lydia Schorr Silverman, President
Suite 404, 505 Eighth Avenue, New York, NY 10018
Provider Number: 29520
Administrative Office:
Telephone - (212)-643-8811 Ext 300
Certificate Number: 240610365
5th & 6th Floors-Medical Services Only, 1st, 2nd, 3rd, 4th Floors, 311 West 35th Street, , New York, New York 10001
Effective: 10/01/2021 6/30/2024
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 1000Service Type:
Program Name:
Certified Capacity:PRU 1483
with Telepractice Designation
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10365_WestMi.pdf
Certificate Number: 201011288
Rooms 417-421, 423-433, 435, 442, 444-446, 4th Floor, 505 Eighth Avenue, , New York, New York 10018
Effective: 07/03/2020 10/31/2020
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51843
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11288_WestMi.pdf
Westchester County Health Care Corporation and HealthAlliance, Inc. as Active Parents HealthAlliance Hospital
Mr. Michael E. Doyle, Executive Director&Chief Medical Officer
HealthAlliance Hospital Broadway Campus as Operator, 396 Broadway, Kingston, NY 12401
Provider Number: 83190
Administrative Office:
Telephone -
Certificate Number: 220310591
10 Barbarossa Lane, Kingston, New York 12401
Effective: 04/01/2020 3/31/2022
Program Location:
Renewal Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51244
Outpatient Rehabilitation Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51923
2905-2 Route 9W, Saugerties, NY 12477
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10591_Westch.pdf
January 31, 2022 Page 222 of 227
Certificate Number: 230911585
2 Barbarossa Lane, Kingston, New York 12401
Effective: 10/01/2020 9/30/2023
Program Location:
Renewal Anticipated Recert Review:
Opioid Treatment Program (822) 200Service Type:
Program Name:
Certified Capacity:PRU 52106
Capacity Lifted
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11585_Westch.pdf
Westchester County Health Care Corporation and HealthAlliance, Inc. as Active Parents HealthAlliance Hospital
Mr. Michael Doyle, Interim Executive Director
HealthAlliance Hospital Mary's Avenue Campus as Operator, 105 Mary's Avenue, Kingston, NY 12401
Provider Number: 81410
Administrative Office:
Telephone - (845)-334-2750
Certificate Number: 230311704
Spellman Building, Room #s 1402, 1403, and 1414, 1st Floor, 105 Mary's Avenue, , Kingston, New York 12401
Effective: 04/01/2020 3/31/2023
Program Location:
Renewal Anticipated Recert Review:
Medically Managed Withdrawal & Stabilization Services (816.6)
First Step
10Service Type:
Program Name:
Certified Capacity:PRU 52517
- with the use of methadone [up to 4 of these beds may be used for the provision of Part 818 inpatient rehabilitation services, as needed]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11704_Westch.pdf
Certificate Number: 230311705
Spellman Building, Room #s 1402, 1403, and 1414, 1st Floor, 105 Mary's Avenue, , Kingston, New York 12401
Effective: 04/01/2020 3/31/2023
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818)
First Step
10Service Type:
Program Name:
Certified Capacity:PRU 52518
[up to 4 of these beds may be used for the provision of Section 816.6 medically managed withdrawal & stabilization services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11705_Westch.pdf
Westchester County Health Care Corporation as Sponsor Mid-Hudson Valley Division of Westchester Medical C
Mr. Michael D. Israel, President and CEO
Mid-Hudson Valley Division of Westchester Medical Center as Operator, 100 Woods Road, Valhalla, NY 10595
Provider Number: 87140
Administrative Office:
Telephone - (914)-493-7017
Certificate Number: 241011841
Spellman Building-5th Floor, Thorne Building-4th Floor, 241 North Road, Poughkeepsie, New York 12601
Effective: 11/01/2021 10/31/2024
Program Location:
Renewal Anticipated Recert Review:
Inpatient Rehabilitation Service ( 818) 50Service Type:
Program Name:
Certified Capacity:PRU 52760
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11841_Westch.pdf
January 31, 2022 Page 223 of 227
Certificate Number: 220811842
201 South Avenue, Executive Parks, Poughkeepsie, New York 12601
Effective: 09/01/2021 8/31/2022
Program Location:
Conditional Certificate Anticipated Recert Review:
Outpatient Service (822)
Turning Point
Service Type:
Program Name:
Certified Capacity:PRU 52759
with Telepractice Designation
Outpatient Rehabilitation Service (822)
Turning Point
Service Type:
Program Name:
Certified Capacity:PRU 52758
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11842_Westch.pdf
Certificate Number: 221111843
Spellman Building, 4th and 5th Floors, 241 North Road, , Poughkeepsie, New York 12601
Effective: 12/01/2019 11/30/2022
Program Location:
Renewal Anticipated Recert Review:
Medically Managed Withdrawal & Stabilization Services (816.6) 10Service Type:
Program Name:
Certified Capacity:PRU 52761
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11843_Westch.pdf
Westfall Associates, Inc.
Mr. Charles Montante, President
Building B, Suite 60, 919 Westfall Road, Rochester, NY 14618
Provider Number: 85059
Administrative Office:
Telephone - (585)-473-1500 Ext 213
Certificate Number: 210311105
Building B, Suite 60, 1st Floor, 919 Westfall Road, Rochester, New York 14618
Effective: 06/03/2020 3/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51102
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11105_Westfa.pdf
Whitney M. Young, Jr. Health Center, Inc.
Mr. David Shippee, Chief Executive Officer
920 Lark Drive, Albany, NY 12207
Provider Number: 35200
Administrative Office:
Telephone - (518)-465-4771
Certificate Number: 220910369
1st & 2nd Floors, 10 DeWitt Street, Albany, New York 12207
Effective: 02/18/2021 9/30/2022
Program Location:
Amendment Anticipated Recert Review:
Opioid Treatment Program (822) 350Service Type:
Program Name:
Certified Capacity:PRU 1631
Capacity Lifted
Opioid Medical Maintenance (822) 0Service Type:
Program Name:
Certified Capacity:PRU 53011
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10369_Whitne.pdf
January 31, 2022 Page 224 of 227
Certificate Number: 220110598
2nd Floor, 10 DeWitt Street, , Albany, New York 12207
Effective: 01/06/2022 5/7/2022
Program Location:
Emergency Anticipated Recert Review:
Outpatient Service (822)
F.A.C.T.S.
Service Type:
Program Name:
Certified Capacity:PRU 50855
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10598_Whitne.pdf
Wholeview Wellness, LLC
Sarah Church Ph.D., CEO/Executive Director
Suite 14A, 14th Floor, 369 Lexington Avenue, New York, NY 10017
Provider Number: 50840
Administrative Office:
Telephone - (212)-204-8430
Certificate Number: 201012211
Suite 14A, 14th Floor, 369 Lexington Avenue, , New York, New York 10017
Effective: 11/01/2019 10/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 53321
with Telepractice Designation [with ancillary withdrawal services]
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/12211_Wholev.pdf
The William George Agency for Children's Services, Inc.
Ms. Helen Hulings, Executive Director
380 Freeville Road, Freeville, NY 13068
Provider Number: 11710
Administrative Office:
Telephone - (607)-844-6243
Certificate Number: 210811566
Van Clef Building, 1st, 2nd, & 3rd Floors, 380 Freeville Road, Freeville, New York 13068
Effective: 05/28/2020 8/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 51772
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11566_Willia.pdf
The Young Men's Christian Association of Long Island, Incorporated
Ms. Stacey Spata, Executive Director
Suite 6, 1150 Portion Road, Holtsville, NY 11742
Provider Number: 352
Administrative Office:
Telephone - (631)-580-7777 Ext 104
Certificate Number: 220511543
Suite 6, 1150 Portion Road, Holtsville, New York 11742
Effective: 10/02/2020 5/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Family Services
Service Type:
Program Name:
Certified Capacity:PRU 1203
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11543_YoungM.pdf
Young Men's Christian Association of Greater New York
Ms. Jacqueline Filis, Executive Director
3911 Richmond Avenue, Staten Island, NY 10312
Provider Number: 20860
Administrative Office:
Telephone - (718)-948-3232
January 31, 2022 Page 225 of 227
Certificate Number: 211111111
3911 Richmond Avenue, Staten Island, New York 10312
Effective: 06/10/2020 11/30/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Staten Island YMCA Counseling Service
Service Type:
Program Name:
Certified Capacity:PRU 7209
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11111_YoungM.pdf
Certificate Number: 220511760
1st Floor, 285 Vanderbilt Avenue, Staten Island, New York 10304
Effective: 06/10/2020 5/31/2022
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)
Staten Island YMCA Counseling Service
Service Type:
Program Name:
Certified Capacity:PRU 52604
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11760_YoungM.pdf
Certificate Number: 240911970
3911 Richmond Avenue, Staten Island, New York 10312
Effective: 10/01/2021 9/30/2024
Program Location:
Renewal Anticipated Recert Review:
Prevention Counseling
Staten Island Branch
Service Type:
Program Name:
Certified Capacity:PRU 90765
with Telepractice Designation
Prevention Counseling, 285 Vanderbilt Avenue, Staten Island, NY 10304
Other Service Site(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11970_YoungM.pdf
The Young Women's Christian Association of Rochester and Monroe County, N.Y.
Ms. Myra Henry, President and Chief Executive Officer
175 North Clinton Avenue, Rochester, NY 14604
Provider Number: 10940
Administrative Office:
Telephone - (585)-368-2280
Certificate Number: 181210008
175 North Clinton Avenue, Rochester, New York 14604
Effective: 01/01/2018 12/31/2018
Program Location:
Special ReIssue Anticipated Recert Review:
Supportive Living (819)
Steppingstone Supportive Living
29Service Type:
Program Name:
Certified Capacity:PRU 51479
with Telepractice Designation
and up to 46 beds for children
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/10008_YoungW.pdf
Youth and Family Counseling Agency of Oyster Bay - East Norwich, Inc.
Ms. Barbara Rakusin, Executive Director
193A South Street, Oyster Bay, NY 11771
Provider Number: 358
Administrative Office:
Telephone - (516)-922-6867
January 31, 2022 Page 226 of 227
Certificate Number: 201211549
193A South Street, , Oyster Bay, New York 11771
Effective: 08/25/2020 12/31/2020
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 682
with Telepractice Designation
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11549_Youtha.pdf
Youth Environmental Services, Inc. d/b/a YES Community Counseling Center
Ms. Adrienne LoPresti, Executive Director
75 Grand Avenue, Massapequa, NY 11758
Provider Number: 1380
Administrative Office:
Telephone - (516)-799-3203
Certificate Number: 210111229
75 Grand Avenue, Massapequa, New York 11758
Effective: 06/22/2020 1/31/2021
Program Location:
Amendment Anticipated Recert Review:
Outpatient Service (822)Service Type:
Program Name:
Certified Capacity:PRU 7115
with Telepractice Designation
2nd Floor, 152 Center Lane, Levittown, NY 11756
Additional Location(s) At:
Compliance Performance Data http://webapps.oasas.ny.gov/legal/CertApp/Directory/documents/11229_YouthE.pdf
January 31, 2022 Page 227 of 227