Healthcare Provider Details

I. General information

NPI: 1124099700
Provider Name (Legal Business Name): TIOGA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 STATE ROUTE 38
OWEGO NY
13827-3209
US

IV. Provider business mailing address

1062 STATE ROUTE 38 PO BOX 177
OWEGO NY
13827-3209
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-0200
  • Fax: 607-687-0248
Mailing address:
  • Phone: 607-687-0200
  • Fax: 607-687-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6893100A/B
License Number StateNY

VIII. Authorized Official

Name: MS. LORI MORGAN
Title or Position: DIRECTOR OF COMMUNITY SERVICES
Credential: LCSW-R
Phone: 607-687-0200