Healthcare Provider Details

I. General information

NPI: 1114056777
Provider Name (Legal Business Name): GREENE COUNTY PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 02/28/2024
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MAIN STREET 3RD FLOOR, SUITE 300
CATSKILL NY
12414-1358
US

IV. Provider business mailing address

411 MAIN STREET 3RD FLOOR, SUITE 300
CATSKILL NY
12414-1358
US

V. Phone/Fax

Practice location:
  • Phone: 518-719-3617
  • Fax: 518-719-3779
Mailing address:
  • Phone: 518-719-3617
  • Fax: 518-719-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number1952200R
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LAUREN CLARK
Title or Position: EARLY INTERVENTION OFFICIAL
Credential: REGISTERED NURSE
Phone: 518-719-3617