Healthcare Provider Details

I. General information

NPI: 1720174436
Provider Name (Legal Business Name): HERKIMER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N WASHINGTON ST STE 2470
HERKIMER NY
13350-1299
US

IV. Provider business mailing address

301 N WASHINGTON ST STE 2470
HERKIMER NY
13350-1299
US

V. Phone/Fax

Practice location:
  • Phone: 315-867-1465
  • Fax: 315-867-1469
Mailing address:
  • Phone: 315-867-1465
  • Fax: 315-867-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6690100A
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6690100A
License Number StateNY

VIII. Authorized Official

Name: MR. EDGAR ROGERS SCUDDER
Title or Position: DIRECTOR OF COMMUNITY SERVICES
Credential: LCSW
Phone: 315-867-1465