Healthcare Provider Details

I. General information

NPI: 1487940870
Provider Name (Legal Business Name): MENTAL HEALTH ASSOCIATION IN ESSEX COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6096 NYS ROUTE 9N
WESTPORT NY
12993-2307
US

IV. Provider business mailing address

6096 NYS ROUTE 9N
WESTPORT NY
12993-2307
US

V. Phone/Fax

Practice location:
  • Phone: 518-962-2077
  • Fax: 518-962-8233
Mailing address:
  • Phone: 518-962-2077
  • Fax: 518-962-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. VALERIE JUNE AINSWORTH
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW-R
Phone: 518-962-2077