Healthcare Provider Details

I. General information

NPI: 1609925817
Provider Name (Legal Business Name): FAMILY SERVICE SOCIETY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PRINCETON AVE EXT
CORNING NY
14830-1524
US

IV. Provider business mailing address

280 PRINCETON AVE EXT
CORNING NY
14830-1524
US

V. Phone/Fax

Practice location:
  • Phone: 607-962-3148
  • Fax: 607-962-8422
Mailing address:
  • Phone: 607-962-3148
  • Fax: 607-962-8422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBIN FOSTER
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 607-962-3148