Healthcare Provider Details

I. General information

NPI: 1407280225
Provider Name (Legal Business Name): SOUTHERN TIER SPECIAL NEEDS RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 MARGARET ST
JOHNSON CITY NY
13790-3016
US

IV. Provider business mailing address

38 MARGARET ST
JOHNSON CITY NY
13790-3016
US

V. Phone/Fax

Practice location:
  • Phone: 607-206-4799
  • Fax: 607-797-7601
Mailing address:
  • Phone: 607-206-4799
  • Fax: 607-797-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY THERESA SCHRADER
Title or Position: OWNER / MANAGING MEMBER
Credential: PHD
Phone: 607-206-4799