Healthcare Provider Details

I. General information

NPI: 1942787700
Provider Name (Legal Business Name): CHARITY LYNN TRAINHAM MSW INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARITY LYNN NORTZ

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6278 PINE GROVE RD
GLENFIELD NY
13343-1805
US

IV. Provider business mailing address

50 DIETZ ST STE J
ONEONTA NY
13820-1865
US

V. Phone/Fax

Practice location:
  • Phone: 315-771-1683
  • Fax:
Mailing address:
  • Phone: 315-269-4859
  • Fax: 315-779-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: