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General NPI Number Information
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NPI Number | 1093909780
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Entity Type | Organization
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Legal Business Name | SUITE E, INC.
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 3209 VESTAL PKWY SUITE E
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City | VESTAL
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State | NY
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Zip | 13850-2154
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Country | US
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Telephone | 607-729-3003
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Fax | 607-729-3004
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Provider Business Mailing Address
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Address Line | 3209 VESTAL PKWY SUITE E
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City | VESTAL
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State | NY
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Zip | 13850-2154
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Country | US
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Telephone | 607-729-3003
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Fax | 607-729-3004
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JODI SUE LOWRY
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Credential | L-CSW-R
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Telephone | 607-729-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | R053915
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | R053915
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License Number State | NY
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