Healthcare Provider Details

I. General information

NPI: 1376301390
Provider Name (Legal Business Name): CHARLENE M. CROSS LICENSED CLINICAL SOCIAL WORKER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 ROUTE 23 STE 3
WINDHAM NY
12496-1510
US

IV. Provider business mailing address

PO BOX 176
WINDHAM NY
12496-0176
US

V. Phone/Fax

Practice location:
  • Phone: 585-481-5270
  • Fax:
Mailing address:
  • Phone: 585-481-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHARLENE CROSS
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 518-321-5369