Healthcare Provider Details

I. General information

NPI: 1831145101
Provider Name (Legal Business Name): COUNTY OF OTSEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MAIN ST
ONEONTA NY
13820-2527
US

IV. Provider business mailing address

242 MAIN ST
ONEONTA NY
13820-2527
US

V. Phone/Fax

Practice location:
  • Phone: 607-433-2343
  • Fax: 607-433-6229
Mailing address:
  • Phone: 607-433-2343
  • Fax: 607-433-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6635100A
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN A MATT
Title or Position: DIRECTOR OF COMMUNITY SERVICES
Credential: LCSW/CASAC
Phone: 607-433-2343