Healthcare Provider Details

I. General information

NPI: 1326015553
Provider Name (Legal Business Name): GREENE COUNTY PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MAIN ST. 3RD FLOOR
CATSKILL NY
12414-1358
US

IV. Provider business mailing address

411 MAIN ST 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 TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number1952600
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LAUREN CLARK
Title or Position: DIRECTOR OF SERVICES FOR CHILDREN W
Credential: RN, BSN
Phone: 518-719-3617