Healthcare Provider Details

I. General information

NPI: 1073549796
Provider Name (Legal Business Name): WARREN WASHINGTON ASSOCIATION FOR MENTAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3043 STATE ROUTE 4
HUDSON FALLS NY
12839-9632
US

IV. Provider business mailing address

3043 STATE ROUTE 4
HUDSON FALLS NY
12839-9632
US

V. Phone/Fax

Practice location:
  • Phone: 518-747-2284
  • Fax: 518-747-2253
Mailing address:
  • Phone: 518-747-2284
  • Fax: 518-747-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PETER GROFF
Title or Position: CEO
Credential:
Phone: 518-747-2284