Healthcare Provider Details

I. General information

NPI: 1467555243
Provider Name (Legal Business Name): OTSEGO COUNTY COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 COUNTY HIGHWAY 33W SUITE 1
COOPERSTOWN NY
13326-4953
US

IV. Provider business mailing address

242 MAIN ST SECOND FLOOR
ONEONTA NY
13820-2527
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-1600
  • Fax: 607-547-1607
Mailing address:
  • Phone: 607-431-1030
  • Fax: 607-431-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number061110917
License Number StateNY

VIII. Authorized Official

Name: MS. SUSAN A MATT
Title or Position: DIRECTOR OF COMMUNITY SERVICES
Credential: LCSW/CASAC
Phone: 607-433-2343