Healthcare Provider Details

I. General information

NPI: 1740227214
Provider Name (Legal Business Name): COUNTY OF ORANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 PIKE STREET
PORT JERVIS NY
12771
US

IV. Provider business mailing address

30 HARRMAN DRIVE
GOSHEN NY
10924
US

V. Phone/Fax

Practice location:
  • Phone: 845-858-1456
  • Fax: 845-858-1459
Mailing address:
  • Phone: 845-291-2600
  • Fax: 845-291-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number7201109A
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number7201109A
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number7201109A
License Number StateNY

VIII. Authorized Official

Name: INDIRA SMITH
Title or Position: PROGRAM EVALUATION ASSISTANT
Credential:
Phone: 845-291-2902