Healthcare Provider Details

I. General information

NPI: 1356619753
Provider Name (Legal Business Name): ST. CATHERINE'S CENTER FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MAIN AVE
ALBANY NY
12203-1410
US

IV. Provider business mailing address

30 N MAIN AVE
ALBANY NY
12203-1410
US

V. Phone/Fax

Practice location:
  • Phone: 518-453-6710
  • Fax:
Mailing address:
  • Phone: 518-453-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number72081040
License Number StateNY

VIII. Authorized Official

Name: SUSAN SACCO
Title or Position: PRIMARY THERAPIST/SOCIAL WORKER
Credential: LMSW
Phone: 518-453-6710