Healthcare Provider Details

I. General information

NPI: 1609025998
Provider Name (Legal Business Name): CATHOLIC CHARITIES COMMUNITY SERVICES OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

520 STATE ROUTE 17M
MONROE NY
10950-3455
US

IV. Provider business mailing address

224 MAIN ST 2ND FLOOR
GOSHEN NY
10924-2157
US

V. Phone/Fax

Practice location:
  • Phone: 845-782-0295
  • Fax: 845-782-5164
Mailing address:
  • Phone: 845-294-5124
  • Fax: 845-294-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number090111577
License Number StateNY

VIII. Authorized Official

Name: DEAN SCHER
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D, L.C.S.W.
Phone: 845-294-5124