Healthcare Provider Details

I. General information

NPI: 1952512725
Provider Name (Legal Business Name): SENECA COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 THURBER DR
WATERLOO NY
13165-1600
US

IV. Provider business mailing address

31 THURBER DR
WATERLOO NY
13165-1600
US

V. Phone/Fax

Practice location:
  • Phone: 315-539-1920
  • Fax: 315-539-9493
Mailing address:
  • Phone: 315-539-1920
  • Fax: 315-539-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number1239L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1239L001
License Number StateNY

VIII. Authorized Official

Name: VICKIE SWINEHART
Title or Position: PUBLIC HEALTH DIRECTOR
Credential: R.N.
Phone: 315-539-1920